Provider Demographics
NPI:1811610827
Name:CHEMBURKAR, TANVI SURESH
Entity type:Individual
Prefix:DR
First Name:TANVI
Middle Name:SURESH
Last Name:CHEMBURKAR
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 1:284 3RD ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2707
Mailing Address - Country:US
Mailing Address - Phone:120-168-7533
Mailing Address - Fax:
Practice Address - Street 1:284 3RD ST APT 2B
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2707
Practice Address - Country:US
Practice Address - Phone:120-168-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029140001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice