Individual ProviderTara DohertySpecialistOther Service ProvidersPractice Address329 E 149th St Fl 4, Bronx, NY 10451-5626(718) 769-2698PECOS EnrollmentBased on the most recent information from CMS, provider Tara Doherty does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 8:41 AM.Profile DetailsProvider ID1942831706Provider TypeIndividualFull NameDoherty, TaraGenderFemaleSole ProprietorNoEnumeration Date1/30/2020Last Updated1/30/2020Contact InformationPractice LocationPractice Address329 E 149th St Fl 4, Bronx, NY 10451-5626Phone(718) 769-2698FaxUnlisted FaxMailing LocationMailing Address329 E 149th St Fl 4, Bronx, NY 10451-5626PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseUnlisted Issuer