Provider Demographics
NPI:1144940156
Name:NIELSEN, TARA (OSC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:OSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-0006
Mailing Address - Country:US
Mailing Address - Phone:631-286-0343
Mailing Address - Fax:631-569-2007
Practice Address - Street 1:12 MORICHES ISLAND RD
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1364
Practice Address - Country:US
Practice Address - Phone:516-449-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty