MEDICARE: RONALD WILLIAM TANDAZO DPT

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	225100000X	Physical Therapist	304360	CA

General Provider Information

NPI Number	:	1427537422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD WILLIAM TANDAZO DPT

Provider Business Mailing Address
First Line	:	3436 KINGSBRIDGE AVE APT 4G
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4069
Country	:	US
Telephone Number	:	646-577-7091
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 KINGSBRIDGE AVE APT 4G
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4069
Country	:	US
Telephone Number	:	646-577-7091
Fax Number	:

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	06/09/2026

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