Provider Demographics
NPI:1649235516
Name:TAVARES, ROSAANABELA RENAUD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSAANABELA
Middle Name:RENAUD
Last Name:TAVARES
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 1:17821 DALNY RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3037
Mailing Address - Country:US
Mailing Address - Phone:646-942-6518
Mailing Address - Fax:
Practice Address - Street 1:682 UNION AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3552
Practice Address - Country:US
Practice Address - Phone:516-571-9500
Practice Address - Fax:516-571-9557
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02733168Medicaid
NYA400221010OtherMEDICARE PART B
WI331952Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
H76309Medicare UPIN
WI331943Medicare Oscar/Certification
NY331954Medicare PIN
NY00695941Medicaid
WI331978Medicare Oscar/Certification
NY02733168Medicaid
WI331945Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
NY0105WSMedicare ID - Type Unspecified
WI331947Medicare Oscar/Certification