Provider Demographics
NPI:1831134717
Name:HE, TINA Q (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:Q
Last Name:HE
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:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8925
Mailing Address - Country:US
Mailing Address - Phone:212-202-0680
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:STE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4553
Practice Address - Country:US
Practice Address - Phone:212-202-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02597982Medicaid
NYI15481Medicare UPIN
NY02597982Medicaid