Tara Broccolo
NPI #1821495581 in Irondequoit, New York
Provider Information
- NPI Number
- 1821495581
- Entity Type
- Individual
- Name
- Tara Broccolo
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Specialist
- Enumeration Date
- Nov 24, 2014
- Last Updated
- Nov 24, 2014
Practice Location
- Address
- 2111 HUDSON AVE
- City
- Irondequoit
- State
- New York
- ZIP Code
- 14617-4346
- Phone
- (585) 520-1783
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist |
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