Provider Demographics
NPI:1417049057
Name:TANAEL, EMILY JANE (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:TANAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MERCEDES WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:631-274-2904
Mailing Address - Fax:631-274-2539
Practice Address - Street 1:51 MERCEDES WAY
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:631-274-2904
Practice Address - Fax:631-274-2539
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY41N611Medicare ID - Type Unspecified
NYG82389Medicare UPIN