Healthcare Provider Details

I. General information

NPI: 1922377258
Provider Name (Legal Business Name): POOJA TANDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOSPITAL DR STE 12
TOMS RIVER NJ
08755-6434
US

IV. Provider business mailing address

7925 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2128
US

V. Phone/Fax

Practice location:
  • Phone: 732-244-2299
  • Fax:
Mailing address:
  • Phone: 516-713-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number25MA09829300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: