Basic Information
| Provider Information | |||||||||
| NPI: | 1356668172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESSONO | ||||||||
| FirstName: | NATACHA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3414 CHURCH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186302197 | ||||||||
| FaxNumber: | 7189402914 | ||||||||
| Practice Location | |||||||||
| Address1: | 1231 DEER PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117033104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316670388 | ||||||||
| FaxNumber: | 6319687705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2010 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 278399 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 278399 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.