Basic Information
| Provider Information | |||||||||
| NPI: | 1396904371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAVANA | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4422 3RD AVE | ||||||||
| Address2: | ST BARNABAS HOSPITAL, DEPT OF PEDIATRICS | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 E 188TH ST | ||||||||
| Address2: | UNION COMMUNITY HEALTH CENTER, DEPT PEDIATRICS | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182202020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 07/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 251728 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.