Provider Demographics
NPI:1215216551
Name:NIEDZIALKOWSKI, TARA MICHELLE (PA)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MICHELLE
Last Name:NIEDZIALKOWSKI
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:43 CLEVELAND AVE
Mailing Address - Street 2:APARTMENT #2
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-3221
Mailing Address - Country:US
Mailing Address - Phone:607-759-4832
Mailing Address - Fax:
Practice Address - Street 1:55 CALVARY DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1032
Practice Address - Country:US
Practice Address - Phone:607-336-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2012-01-03
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical