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General NPI Number Information
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NPI Number | 1275668527
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Entity Type | Organization
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Legal Business Name | MIGUEL A. TIRADO, MD PLLC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 SEGUINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3730
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Country | US
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Telephone | 718-967-0330
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Fax | 732-608-6639
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Provider Business Mailing Address
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Address Line | PO BOX 61667
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City | STATEN ISLAND
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State | NY
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Zip | 10306-7667
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Country | US
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Telephone | 718-967-0330
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Fax | 732-608-6639
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Authorized Official
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Title or Position | MD
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Name | DR. MIGUEL A TIRADO
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Credential | MD
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Telephone | 718-967-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 203529
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License Number State | NY
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