Provider Demographics
NPI:1194191239
Name:TUFANO, MARY JANE
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:
Last Name:TUFANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY JANE
Other - Middle Name:
Other - Last Name:JUDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:439 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1707
Mailing Address - Country:US
Mailing Address - Phone:516-763-1596
Mailing Address - Fax:
Practice Address - Street 1:439 JACKSON ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1707
Practice Address - Country:US
Practice Address - Phone:516-763-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006417821174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist