Provider Demographics
NPI:1629046131
Name:IANCHULEV, TSONTCHO ALEXANDROV (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:TSONTCHO
Middle Name:ALEXANDROV
Last Name:IANCHULEV
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 14TH ST STE 319
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4284
Mailing Address - Country:US
Mailing Address - Phone:617-216-4369
Mailing Address - Fax:332-237-5156
Practice Address - Street 1:310 E 14TH ST STE 319
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4284
Practice Address - Country:US
Practice Address - Phone:617-216-4369
Practice Address - Fax:332-237-5156
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2817821207W00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI02782Medicare UPIN