Provider Demographics
NPI:1194040592
Name:TEJANI, BEHRAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:BEHRAM
Middle Name:
Last Name:TEJANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MAYBERRY PROMENADE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6414
Mailing Address - Country:US
Mailing Address - Phone:718-967-4239
Mailing Address - Fax:
Practice Address - Street 1:519 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3501
Practice Address - Country:US
Practice Address - Phone:718-720-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist