Provider Demographics
NPI:1164114948
Name:UDDIN, TANZILA
Entity Type:Individual
Prefix:
First Name:TANZILA
Middle Name:
Last Name:UDDIN
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 1:222 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2223
Mailing Address - Country:US
Mailing Address - Phone:917-943-7424
Mailing Address - Fax:
Practice Address - Street 1:222 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2223
Practice Address - Country:US
Practice Address - Phone:917-943-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118257-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health