Healthcare Provider Details

I. General information

NPI: 1063855435
Provider Name (Legal Business Name): TIGA PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 BAINBRIDGE AVE S5
BRONX NY
10467-1409
US

IV. Provider business mailing address

PO BOX 672170
BRONX NY
10467-0803
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-8999
  • Fax: 718-881-1984
Mailing address:
  • Phone: 718-881-8999
  • Fax: 718-881-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number209367
License Number StateNY

VIII. Authorized Official

Name: TOSAN ORUWARIYE
Title or Position: OWNER
Credential: M.D.
Phone: 718-881-8999