Provider Demographics
NPI:1043223647
Name:TEJERO, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:TEJERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:MONTGOMERY ST
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-0029
Mailing Address - Country:US
Mailing Address - Phone:845-876-7081
Mailing Address - Fax:845-876-7515
Practice Address - Street 1:91 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-0029
Practice Address - Country:US
Practice Address - Phone:845-876-7081
Practice Address - Fax:845-876-7515
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY113841208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B16531Medicare UPIN
562951Medicare ID - Type Unspecified