Healthcare Provider Details

I. General information

NPI: 1952252728
Provider Name (Legal Business Name): TANZIM IMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. JOHN'S EPISCOPAL HOSPITAL, 327 BEACH 19TH STREET
FAR ROCKAWAY NY
11691
US

IV. Provider business mailing address

ST. JOHN'S EPISCOPAL HOSPITAL, 327 BEACH 19TH STREET
FAR ROCKAWAY NY
11691
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-7672
  • Fax: 718-869-8530
Mailing address:
  • Phone:
  • Fax: 718-869-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: