Provider Demographics
NPI:1346367505
Name:TEJARATCHI, NASSER M (MD)
Entity Type:Individual
Prefix:MR
First Name:NASSER
Middle Name:M
Last Name:TEJARATCHI
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 1:1101 WHITE PLAINS ROAD
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472
Mailing Address - Country:US
Mailing Address - Phone:718-863-3941
Mailing Address - Fax:
Practice Address - Street 1:1101 WHITE PLAINS ROAD
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472
Practice Address - Country:US
Practice Address - Phone:718-863-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00163864Medicaid
B19894Medicare UPIN
NY00163864Medicaid