Provider Demographics
NPI:1164449161
Name:TUGETMAN, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:TUGETMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1811
Mailing Address - Country:US
Mailing Address - Phone:914-448-2273
Mailing Address - Fax:914-448-2200
Practice Address - Street 1:359 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1811
Practice Address - Country:US
Practice Address - Phone:914-448-2273
Practice Address - Fax:914-448-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01909613Medicaid
NY1164449161OtherNPI
NY5129C1OtherMEDICARE ID
NY5129C1OtherMEDICARE ID
NY5129C1OtherMEDICARE ID