MEDICARE: DR. JITENDRA N. TOLIA 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	207RP1001X	Pulmonary Disease Physician	174996	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	315221	OTHER	NY	WELLCARE MEDICARE

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	0M058P	OTHER	NY	HIP
4	517699	OTHER	NY	AETNA USHEALTHCARE
5	45F931	OTHER	NY	EMPIRE BLUECROSS BLUESHIE
6	50545	OTHER	NY	VYTRA
7	DP156	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1407974199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JITENDRA N. TOLIA M.D.

Provider Business Mailing Address
First Line	:	3147 77TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1824
Country	:	US
Telephone Number	:	718-429-4444
Fax Number	:	718-639-5353

Provider Business Practice Location Address
First Line	:	3147 77TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1824
Country	:	US
Telephone Number	:	718-429-4444
Fax Number	:	718-639-5353

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. JITENDRA N. TOLIA M.D.” Practice Location

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