MEDICARE: ESTHER TIFFANY DAVIS D.O.

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	208000000X	Pediatrics Physician	305081	NY
2	2080P0206X	Pediatric Gastroenterology Physician	305081	NY

General Provider Information

NPI Number	:	1528401452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER TIFFANY DAVIS D.O.

Provider Business Mailing Address
First Line	:	3411 WAYNE AVE FL 7
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2552
Country	:	US
Telephone Number	:	718-741-2332
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 WAYNE AVE FL 7
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2552
Country	:	US
Telephone Number	:	718-741-2332
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	10/21/2020

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