Provider Demographics
NPI:1740559368
Name:TIGARIS, KAMEELAH
Entity Type:Individual
Prefix:
First Name:KAMEELAH
Middle Name:
Last Name:TIGARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEWATER ST
Mailing Address - Street 2:PATHOLOGY DEPARTMENT
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4907
Mailing Address - Country:US
Mailing Address - Phone:718-226-4130
Mailing Address - Fax:
Practice Address - Street 1:1 EDGEWATER ST
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4907
Practice Address - Country:US
Practice Address - Phone:718-226-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256023207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400059665Medicare PIN