Provider Demographics
NPI:1497811723
Name:TASNEEM, UNKNOWN (MD)
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:TASNEEM
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 1:14705 SANFORD AVE
Mailing Address - Street 2:APT L2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-358-3100
Mailing Address - Fax:718-358-1140
Practice Address - Street 1:14705 SANFORD AVE
Practice Address - Street 2:APT L2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-358-3100
Practice Address - Fax:718-358-1140
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163911208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0995620Medicaid
NY0995620Medicaid