Basic Information
| Provider Information | |||||||||
| NPI: | 1770678005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANAEL | ||||||||
| FirstName: | LORETO | ||||||||
| MiddleName: | VERGARA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 NOSTRAND AVE | ||||||||
| Address2: | ATTENTION CELESTE JACKSON | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188263911 | ||||||||
| FaxNumber: | 7188263860 | ||||||||
| Practice Location | |||||||||
| Address1: | 3245 NOSTRAND AVE | ||||||||
| Address2: | KINGS HWY CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186153777 | ||||||||
| FaxNumber: | 7186153481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 1138351 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.