Provider Demographics
NPI:1275281834
Name:TEJADA, MIRKA
Entity Type:Individual
Prefix:
First Name:MIRKA
Middle Name:
Last Name:TEJADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 61ST ST APT 1715
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-0234
Mailing Address - Country:US
Mailing Address - Phone:646-343-7449
Mailing Address - Fax:
Practice Address - Street 1:400 W 61ST ST APT 1715
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-0234
Practice Address - Country:US
Practice Address - Phone:646-343-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator