Provider Demographics
NPI:1083475032
Name:DR. ARSENIO M. TIO MEDICAL PRACTICE
Entity Type:Organization
Organization Name:DR. ARSENIO M. TIO MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:ARSENIO
Authorized Official - Last Name:TIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-977-4439
Mailing Address - Street 1:231 SHERMAN AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2511
Mailing Address - Country:US
Mailing Address - Phone:212-567-4770
Mailing Address - Fax:718-732-2580
Practice Address - Street 1:231 SHERMAN AVE APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2511
Practice Address - Country:US
Practice Address - Phone:212-567-4770
Practice Address - Fax:718-732-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538232962Medicaid
NY1700349016Medicaid