Provider Demographics
NPI:1174536668
Name:ROFFE, TARA HERWITZ (DDS)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:HERWITZ
Last Name:ROFFE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 ATLANTIC AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518
Mailing Address - Country:US
Mailing Address - Phone:516-823-9211
Mailing Address - Fax:516-823-9212
Practice Address - Street 1:433 ATLANTIC AVE
Practice Address - Street 2:STE 1
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518
Practice Address - Country:US
Practice Address - Phone:516-823-9211
Practice Address - Fax:516-823-9212
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist