Provider Demographics
NPI:1245203686
Name:TEJERA, MANUEL G (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:G
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 1:1019 YONKERS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3034
Mailing Address - Country:US
Mailing Address - Phone:914-457-9140
Mailing Address - Fax:914-457-9141
Practice Address - Street 1:1019 YONKERS AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3034
Practice Address - Country:US
Practice Address - Phone:914-457-9140
Practice Address - Fax:914-457-9141
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02001545Medicaid
NY233111Medicare PIN
NYWYRPT1Medicare PIN
NYWYQYY1Medicare PIN
NY02001545Medicaid
NYWYQYZ1Medicare PIN