Basic Information
| Provider Information | |||||||||
| NPI: | 1477137297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TASKA-TENCH | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, MS, CGC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 BRADHURST AVE STE 2850 | ||||||||
| Address2: | |||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105322183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143045280 | ||||||||
| FaxNumber: | 9142341753 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 BRADHURST AVE STE 2850 | ||||||||
| Address2: | |||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105322183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143045280 | ||||||||
| FaxNumber: | 9142341753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2021 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | 16364 | NY | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.