Provider Demographics
NPI:1154627511
Name:TENGSON MEDICAL OFFICE, LLC
Entity Type:Organization
Organization Name:TENGSON MEDICAL OFFICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:CAMBA
Authorized Official - Last Name:TENGSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-615-3284
Mailing Address - Street 1:32 HINE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2955
Mailing Address - Country:US
Mailing Address - Phone:973-742-0046
Mailing Address - Fax:973-742-5824
Practice Address - Street 1:32 HINE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2955
Practice Address - Country:US
Practice Address - Phone:973-742-0046
Practice Address - Fax:973-742-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66349261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7805004Medicaid