MEDICARE: TIGA PEDIATRICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	209367	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	209367	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1063855435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIGA PEDIATRICS PC

Provider Business Mailing Address
First Line	:	PO BOX 672170
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-0803
Country	:	US
Telephone Number	:	718-881-8999
Fax Number	:	718-881-1984

Provider Business Practice Location Address
First Line	:	3510 BAINBRIDGE AVE
Second Line	:	S5
City	:	BRONX
State	:	NY
Zip	:	10467-1409
Country	:	US
Telephone Number	:	718-881-8999
Fax Number	:	718-881-1984

Authorized Official
Title or Position	:	OWNER
Name	:	TOSAN ORUWARIYE
Credential	:	M.D.
Telephone Number	:	718-881-8999

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	09/19/2013

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Directions to “TIGA PEDIATRICS PC ” Practice Location

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