Provider Demographics
NPI:1295147734
Name:TONGO, NOSAKHARE DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:NOSAKHARE
Middle Name:DOUGLAS
Last Name:TONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 FORTUNE CT
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2759
Mailing Address - Country:US
Mailing Address - Phone:347-831-6858
Mailing Address - Fax:
Practice Address - Street 1:BROOKDALE PLAZA
Practice Address - Street 2:ONE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine