Provider Demographics
NPI:1407809916
Name:VIRDEE, TEJINDER S (MD)
Entity Type:Individual
Prefix:
First Name:TEJINDER
Middle Name:S
Last Name:VIRDEE
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 1:181 SENECA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1335
Mailing Address - Country:US
Mailing Address - Phone:607-324-1372
Mailing Address - Fax:607-324-1374
Practice Address - Street 1:181 SENECA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1336
Practice Address - Country:US
Practice Address - Phone:607-324-0660
Practice Address - Fax:607-324-0770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194530208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01685267Medicaid
NYF76002Medicare UPIN
NYA70284Medicare ID - Type Unspecified