Provider Demographics
NPI:1992834683
Name:TARLE, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:TARLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:20 SQUADRON BLVD
Mailing Address - Street 2:# 560
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5200
Mailing Address - Country:US
Mailing Address - Phone:845-639-9650
Mailing Address - Fax:845-639-0727
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:# 560
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5200
Practice Address - Country:US
Practice Address - Phone:845-639-9650
Practice Address - Fax:845-639-0727
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1413482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00725517Medicaid
NYB19391Medicare UPIN
NY00725517Medicaid