Provider Demographics
NPI:1750470837
Name:TAVDY, MAGGIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:TAVDY
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 1:984 N BROADWAY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
Mailing Address - Country:US
Mailing Address - Phone:914-237-4377
Mailing Address - Fax:914-237-4405
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:SUITE 305
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-237-4377
Practice Address - Fax:914-237-4405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211927207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02053189Medicaid
NY02053189Medicaid
NYH22010Medicare UPIN