Provider Demographics
NPI:1174647234
Name:TEJERA, GERTRAUD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERTRAUD
Middle Name:
Last Name:TEJERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0052
Mailing Address - Country:US
Mailing Address - Phone:212-318-4242
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044-0052
Practice Address - Country:US
Practice Address - Phone:212-318-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135677012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF39999Medicare UPIN