MEDICARE: DR. NOORUDDIN RAHMATULLAH TEJANI M.D.,

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	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	206210	NY

General Provider Information

NPI Number	:	1396747135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOORUDDIN RAHMATULLAH TEJANI M.D.,

Provider Business Mailing Address
First Line	:	24 BERKLEY LN
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-6130
Country	:	US
Telephone Number	:	516-921-2369
Fax Number	:

Provider Business Practice Location Address
First Line	:	SUNY DOWNSTATE MEDICAL CENTER,
Second Line	:	450 CLARKSON AVE., BOX 1228
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-270-8241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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