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General NPI Number Information
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NPI Number | 1720402613
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Entity Type | Organization
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Legal Business Name | TUBMAN MD
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 78 CROMWELL AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10304-3912
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Country | US
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Telephone | 718-987-9175
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Fax |
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Provider Business Mailing Address
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Address Line | 100 JOLINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10307-2019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. INNA TUBMAN
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Credential | M.D.
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Telephone | 917-862-4218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 240622
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License Number State | NY
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