Provider Demographics
NPI:1497897268
Name:HOMAYUN, TAHIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAHIRA
Middle Name:
Last Name:HOMAYUN
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 1:20 E 74 ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-861-6663
Mailing Address - Fax:212-734-6622
Practice Address - Street 1:20 E 74 ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-861-6663
Practice Address - Fax:212-734-6622
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125098207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00555940Medicaid
286031Medicare ID - Type Unspecified
NY00555940Medicaid