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General NPI Number Information
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NPI Number | 1790263259
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Entity Type | Organization
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Legal Business Name | TILDEN MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 381 ROCKAWAY AVE
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City | BROOKLYN
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State | NY
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Zip | 11212-5635
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Country | US
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Telephone | 718-522-3400
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Fax | 929-430-0511
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Provider Business Mailing Address
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Address Line | 381 ROCKAWAY AVE
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City | BROOKLYN
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State | NY
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Zip | 11212-5635
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Country | US
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Telephone | 718-522-3400
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Fax | 929-430-0511
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Authorized Official
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Title or Position | OWNER
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Name | HARRY CREVECOEUR
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Credential | MD
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Telephone | 646-373-9624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 184270
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License Number State | NY
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