Tara Jensen

NPI #1992195408 in Lake Ronkonkoma, New York

Provider Information

NPI Number: 1992195408
Entity Type: Individual
Name: Tara Jensen
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Feb 4, 2015
Last Updated: Feb 4, 2015

Practice Location

Address: 7 PINE ST
City: Lake Ronkonkoma
State: New York
ZIP Code: 11779-4260
Phone: (631) 875-3590

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary
Early Intervention Provider Agency	252Y00000X

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