Healthcare Provider Details

I. General information

NPI: 1861061004
Provider Name (Legal Business Name): NIZAR TANGOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 08/19/2024
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 FIRST AVENUE ROOM 523 METROPOLITAN HOSPITAL CENTER - DEPARTMENT OF PEDIATRICS
NEW YORK NY
10029
US

IV. Provider business mailing address

430E 34TH STREET HASSENFELD CHILDREN HOSPITAL, NYU LANGONE
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-7834
  • Fax: 212-534-7831
Mailing address:
  • Phone: 212-263-8400
  • Fax: 212-534-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: