Provider Demographics
NPI:1265646293
Name:BIRENDRA N TANDAN MD LLC
Entity Type:Organization
Organization Name:BIRENDRA N TANDAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BIRENDRA
Authorized Official - Middle Name:NATH
Authorized Official - Last Name:TANDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-561-8625
Mailing Address - Street 1:560 BELLEVUE AVENUE
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 AVENUE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02717700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2871700Medicaid
NJC53628Medicare UPIN