Healthcare Provider Details

I. General information

NPI: 1598020687
Provider Name (Legal Business Name): TAHERA HYDER MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 RAMS HILL RD
GLENWOOD LANDING NY
11547-3016
US

IV. Provider business mailing address

12 RAMS HILL RD
GLENWOOD LANDING NY
11547-3016
US

V. Phone/Fax

Practice location:
  • Phone: 718-938-8045
  • Fax: 718-464-2017
Mailing address:
  • Phone: 718-938-8045
  • Fax: 718-464-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1770581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: