Provider Demographics
NPI:1972707057
Name:TINA DOBSEVAGE,M.D.,P.C.
Entity Type:Organization
Organization Name:TINA DOBSEVAGE,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONTERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-477-3544
Mailing Address - Street 1:1050 5TH AVE OFC 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0110
Mailing Address - Country:US
Mailing Address - Phone:646-672-0763
Mailing Address - Fax:646-672-0741
Practice Address - Street 1:1050 5TH AVE OFC 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0110
Practice Address - Country:US
Practice Address - Phone:646-672-0763
Practice Address - Fax:646-672-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB02559Medicare UPIN
NYW38581Medicare PIN