Provider Demographics
NPI:1134188246
Name:WONDEMUNEGNE, TIRUWORK (DO)
Entity type:Individual
Prefix:
First Name:TIRUWORK
Middle Name:
Last Name:WONDEMUNEGNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 WATERSIDE CLOSE
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5655
Mailing Address - Country:US
Mailing Address - Phone:914-787-8804
Mailing Address - Fax:
Practice Address - Street 1:183RD &3RD AVE
Practice Address - Street 2:ST BARNABAS HOSPITAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-9000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209969-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine