Healthcare Provider Details

I. General information

NPI: 1407896186
Provider Name (Legal Business Name): TAJ M DEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S JACOBI MEDICAL CENTER
BRONX NY
10461-1138
US

IV. Provider business mailing address

31 BONAVENTURE AVE
ARDSLEY NY
10502-2103
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6783
  • Fax: 718-918-6516
Mailing address:
  • Phone: 718-918-6783
  • Fax: 718-918-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number196894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: