Provider Demographics
NPI:1649714718
Name:TARN, MARINA (MA, CCC- SLP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:TARN
Suffix:
Gender:F
Credentials:MA, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11443 142ND ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1024
Mailing Address - Country:US
Mailing Address - Phone:718-558-2070
Mailing Address - Fax:718-322-6035
Practice Address - Street 1:114-43 142ND STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436
Practice Address - Country:US
Practice Address - Phone:718-558-2070
Practice Address - Fax:718-322-6035
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015416-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist