Provider Demographics
NPI:1992068001
Name:CECHNICKI, TARA LYN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYN
Last Name:CECHNICKI
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 1:80 CYPRESS ST APT 201
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1753
Mailing Address - Country:US
Mailing Address - Phone:518-878-5062
Mailing Address - Fax:
Practice Address - Street 1:80 CYPRESS ST APT 201
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1753
Practice Address - Country:US
Practice Address - Phone:518-878-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered