Provider Demographics
NPI:1275668527
Name:MIGUEL A. TIRADO, MD PLLC
Entity Type:Organization
Organization Name:MIGUEL A. TIRADO, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-967-0330
Mailing Address - Street 1:PO BOX 61667
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-7667
Mailing Address - Country:US
Mailing Address - Phone:718-967-0330
Mailing Address - Fax:732-608-6639
Practice Address - Street 1:305 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3730
Practice Address - Country:US
Practice Address - Phone:718-967-0330
Practice Address - Fax:732-608-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203529208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty