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NPI Code Detail

MEDICARE: TUBMAN MD

MEDICARE: TUBMAN MD
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
1207VG0400XGynecology Physician240622NY

General Provider Information

NPI Number : 1720402613
Entity Type Code : Organization
Provider Name (Legal Business Name) : TUBMAN MD
Provider Business Mailing Address
First Line : 100 JOLINE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10307-2019
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 78 CROMWELL AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10304-3912
Country : US
Telephone Number : 718-987-9175
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : DR. INNA TUBMAN
Credential : M.D.
Telephone Number : 917-862-4218
Provider Enumeration Date : 02/12/2014
Last Update Date : 02/12/2014

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Directions to “TUBMAN MD ” Practice Location

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