Provider Demographics
NPI:1427318179
Name:O'BRIEN, TARA (VMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:VMD
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 30452
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-0452
Mailing Address - Country:US
Mailing Address - Phone:516-488-3717
Mailing Address - Fax:
Practice Address - Street 1:2150 HEMPSTEAD TPKE
Practice Address - Street 2:BELMONT PARK RACETRACK GATE 6
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1551
Practice Address - Country:US
Practice Address - Phone:516-488-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10493174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian