Healthcare Provider Details

I. General information

NPI: 1144635004
Provider Name (Legal Business Name): MICHAEL TONSOR II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 ASTORIA BLVD
ASTORIA NY
11102-4751
US

IV. Provider business mailing address

2818 ASTORIA BLVD
ASTORIA NY
11102-4751
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number293612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: