Provider Demographics
NPI:1275556425
Name:TUCHMAN, MARIO (DMD,MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:TUCHMAN
Suffix:
Gender:M
Credentials:DMD,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 71ST ST
Mailing Address - Street 2:11-J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5137
Mailing Address - Country:US
Mailing Address - Phone:310-749-8131
Mailing Address - Fax:
Practice Address - Street 1:353 LEXINGTON AVE
Practice Address - Street 2:SUITE #700
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0941
Practice Address - Country:US
Practice Address - Phone:646-874-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177551223P0106X
NY054229-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology