Healthcare Provider Details

I. General information

NPI: 1992642680
Provider Name (Legal Business Name): TEJASWINI TATOJU PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 NY - 211 E
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

2550 VICTORY BLVD
STATEN ISLAND NY
10314-6611
US

V. Phone/Fax

Practice location:
  • Phone: 917-318-5303
  • Fax:
Mailing address:
  • Phone: 917-318-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: