Basic Information
Provider Information
NPI: 1508467317
EntityType: 2
ReplacementNPI:  
OrganizationName: TUDOR ONISEI MEDICAL, P.C.
LastName:  
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Mailing Information
Address1: PO BOX 270
Address2:  
City: MASSAPEQUA PARK
State: NY
PostalCode: 117620270
CountryCode: US
TelephoneNumber: 6312642030
FaxNumber: 6312641418
Practice Location
Address1: 9229 QUEENS BLVD STE 1A
Address2:  
City: REGO PARK
State: NY
PostalCode: 113741099
CountryCode: US
TelephoneNumber: 7188975700
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/06/2020
LastUpdateDate: 11/06/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: ONISEI
AuthorizedOfficialFirstName: TUDOR
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AuthorizedOfficialTitleorPosition: AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 5168300402
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate: 11/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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