Provider Demographics
NPI:1407974199
Name:TOLIA, JITENDRA N (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:N
Last Name:TOLIA
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 1:3147 77TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1824
Mailing Address - Country:US
Mailing Address - Phone:718-429-4444
Mailing Address - Fax:718-639-5353
Practice Address - Street 1:3147 77TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1824
Practice Address - Country:US
Practice Address - Phone:718-429-4444
Practice Address - Fax:718-639-5353
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174996207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01182374Medicaid
NY0M058POtherHIP
NY315221OtherWELLCARE MEDICARE
NY517699OtherAETNA USHEALTHCARE
NY45F931OtherEMPIRE BLUECROSS BLUESHIE
NY50545OtherVYTRA
NYDP156OtherOXFORD
NY63545Medicare ID - Type Unspecified
NY50545OtherVYTRA