Healthcare Provider Details

I. General information

NPI: 1609404185
Provider Name (Legal Business Name): TIANA SYMONE WOOLRIDGE MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 12/31/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 71ST ST
NEW YORK NY
10021-4828
US

IV. Provider business mailing address

525 E 71ST ST
NEW YORK NY
10021-4828
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number333331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: