Healthcare Provider Details

I. General information

NPI: 1699353805
Provider Name (Legal Business Name): NICOLE ALEXANDRA SALEVITZ TAGTMEYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

V. Phone/Fax

Practice location:
  • Phone: 602-819-1494
  • Fax:
Mailing address:
  • Phone: 602-819-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number343473
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: