Provider Demographics
NPI:1154503183
Name:DUMONT, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:DUMONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26691
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6691
Mailing Address - Country:US
Mailing Address - Phone:212-305-5974
Mailing Address - Fax:212-305-6193
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-5974
Practice Address - Fax:212-305-6193
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant