Healthcare Provider Details

I. General information

NPI: 1881891661
Provider Name (Legal Business Name): TIRSIT SHIFERAW ASFAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # J130
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

560 FIRST AVENUE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
NEW YORK NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-3376
  • Fax: 212-746-0283
Mailing address:
  • Phone: 212-263-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number244461
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: