Healthcare Provider Details

I. General information

NPI: 1407253198
Provider Name (Legal Business Name): SHRUTI TIWARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHRUTI TIWARI MD

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 48TH ST FL 2
BROOKLYN NY
11219-2919
US

IV. Provider business mailing address

929 48TH ST FL 2
BROOKLYN NY
11219-2919
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number282575
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number282575
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: