Provider Demographics
NPI:1588031959
Name:TANI, GEORGE J
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:J
Last Name:TANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 EAST 81ST STREET
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1414
Mailing Address - Country:US
Mailing Address - Phone:212-744-9249
Mailing Address - Fax:212-744-9249
Practice Address - Street 1:106 EAST 81ST STREET
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1414
Practice Address - Country:US
Practice Address - Phone:212-744-9249
Practice Address - Fax:212-744-9249
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0375111104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker