Healthcare Provider Details

I. General information

NPI: 1902854698
Provider Name (Legal Business Name): TSEGA DENNEKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6971 GRAND AVE
MASPETH NY
11378-1825
US

IV. Provider business mailing address

2314 COLLEGE POINT BLVD
COLLEGE POINT NY
11356-2526
US

V. Phone/Fax

Practice location:
  • Phone: 718-507-4400
  • Fax: 718-507-2484
Mailing address:
  • Phone: 347-312-3041
  • Fax: 718-661-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number189235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: