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General NPI Number Information
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NPI Number | 1770014292
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Entity Type | Individual
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Provider Name | TOMMY TEA MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 10 NATHAN D PERLMAN PL
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City | NEW YORK
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State | NY
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Zip | 10003-3841
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Country | US
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Telephone | 203-522-8076
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Fax |
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Provider Business Mailing Address
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Address Line | 605 E 11TH ST APT 4B
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City | NEW YORK
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State | NY
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Zip | 10009-4110
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Country | US
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Telephone | 203-522-8076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 302439
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License Number State | NY
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