Provider Demographics
NPI:1265477616
Name:TANDAN, BIRENDRA NATH (MD)
Entity Type:Individual
Prefix:
First Name:BIRENDRA
Middle Name:NATH
Last Name:TANDAN
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 1:560 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1933
Mailing Address - Country:US
Mailing Address - Phone:609-561-8625
Mailing Address - Fax:609-561-5371
Practice Address - Street 1:560 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1933
Practice Address - Country:US
Practice Address - Phone:609-561-8625
Practice Address - Fax:609-561-5371
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27177208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2871700Medicaid
NJC53628Medicare UPIN
NJ111579Medicare PIN