Provider Demographics
NPI:1750448429
Name:POE, MARY ANN TIONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:TIONG
Last Name:POE
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 1:18875 AVON RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1016
Mailing Address - Country:US
Mailing Address - Phone:718-464-9678
Mailing Address - Fax:718-963-6095
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-630-3299
Practice Address - Fax:718-963-6095
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125230208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice