Provider Demographics
NPI:1295742716
Name:VANNOY, TAMIRA
Entity type:Individual
Prefix:
First Name:TAMIRA
Middle Name:
Last Name:VANNOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2812
Mailing Address - Country:US
Mailing Address - Phone:718-348-5981
Mailing Address - Fax:718-345-5139
Practice Address - Street 1:1027 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2812
Practice Address - Country:US
Practice Address - Phone:718-348-5981
Practice Address - Fax:718-345-5139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5267213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692144Medicaid
NYP51751Medicare PIN
U61975Medicare UPIN
NY5144100001Medicare NSC