=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699785865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATHANIEL L TINDEL MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 E 79TH ST 1H
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-3840
-----------------------------------------------------
Fax | 212-249-5686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 E 79TH ST 1H
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-3840
-----------------------------------------------------
Fax | 212-249-5686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. NATHANIEL L TINDEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-249-3840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 192147
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------