Provider Demographics
NPI:1790263259
Name:TILDEN MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:TILDEN MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-373-9624
Mailing Address - Street 1:381 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5635
Mailing Address - Country:US
Mailing Address - Phone:718-522-3400
Mailing Address - Fax:929-430-0511
Practice Address - Street 1:381 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5635
Practice Address - Country:US
Practice Address - Phone:718-522-3400
Practice Address - Fax:929-430-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184270207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty