Provider Demographics
NPI:1366102444
Name:TARA A BURKE MUSCATELLO NP PSYCHIATRY PLLC
Entity type:Organization
Organization Name:TARA A BURKE MUSCATELLO NP PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURKE MUSCATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:518-782-3815
Mailing Address - Street 1:56 CLIFTON COUNTRY ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3994
Mailing Address - Country:US
Mailing Address - Phone:518-782-3815
Mailing Address - Fax:323-334-1415
Practice Address - Street 1:56 CLIFTON COUNTRY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3994
Practice Address - Country:US
Practice Address - Phone:518-782-3815
Practice Address - Fax:323-334-1415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARA A BURKE MUSCATELLO NP PSYCHIATRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)