National Provider Identifier
Tara Broccolo
Tara Broccolo is listed in the NPPES registry with a primary specialty of Specialist in Irondequoit, NY and a listed phone number of (585) 520-1783.
Profile Overview
- NPI
- 1821495581
- Provider Type
- Individual
- Primary Specialty
- Specialist
- Enumeration Date
- November 24, 2014
- Last Updated
- November 24, 2014
Practice Location
- 2111 Hudson Ave
- Irondequoit, NY 14617-4346
Phone: (585) 520-1783
Mailing Address
- 1628 Glendowan Ter
- Webster, NY 14580-8571
Specialties
- Specialist (174400000X)
Full Record
- NPI
- 1821495581
- Entity Type
- Individual
- Last Name
- Broccolo
- First Name
- Tara
- Mailing Street Address
- 1628 Glendowan Ter
- Mailing City
- Webster
- Mailing State
- NY
- Mailing ZIP Code
- 14580-8571
- Mailing Country
- US
- Mailing Phone
- (585) 520-1783
- Practice Street Address
- 2111 Hudson Ave
- Practice City
- Irondequoit
- Practice State
- NY
- Practice ZIP Code
- 14617-4346
- Practice Country
- US
- Practice Phone
- (585) 520-1783
- Enumeration Date
- November 24, 2014
- Last Updated
- November 24, 2014
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Specialist (174400000X)