Provider Demographics
NPI:1093747073
Name:POWERMAN, TANYA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:POWERMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEWATER STREET
Mailing Address - Street 2:SUITE 723
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-226-1047
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:65 ROSE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2246
Practice Address - Country:US
Practice Address - Phone:718-226-6344
Practice Address - Fax:718-226-0408
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004513213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01122912Medicaid
NYP00752737OtherRAIL ROAD MEDICARE
NYT81582Medicare UPIN
NYP46831Medicare ID - Type Unspecified