Provider Demographics
NPI:1326021742
Name:TEWARI, SANJAY OM (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:OM
Last Name:TEWARI
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 1:9 FRIENDLY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6311
Mailing Address - Country:US
Mailing Address - Phone:212-731-2154
Mailing Address - Fax:718-670-2597
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:3RD FLOOR-CARDIAC ANESTHESIOLOGY
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1080
Practice Address - Fax:718-670-2597
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07926500207L00000X
NY230982207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0071676Medicaid
NYP00724172Medicare PIN
NY006AIMedicare PIN
NJ0071676Medicaid
NJ0071676Medicaid