Provider Demographics
NPI:1215440243
Name:HARDY, TAHEERAH NICOLE
Entity type:Individual
Prefix:
First Name:TAHEERAH
Middle Name:NICOLE
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205
Mailing Address - Country:US
Mailing Address - Phone:908-351-0420
Mailing Address - Fax:908-351-0421
Practice Address - Street 1:1151 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205
Practice Address - Country:US
Practice Address - Phone:908-351-0420
Practice Address - Fax:908-351-0421
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician