Provider Demographics
NPI:1053596007
Name:TENDER MEDICAL CARE PC
Entity type:Organization
Organization Name:TENDER MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:NIRMALA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUMMALAPENTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-379-4444
Mailing Address - Street 1:14 VAN SAUN PL
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4123
Mailing Address - Country:US
Mailing Address - Phone:732-406-5985
Mailing Address - Fax:
Practice Address - Street 1:2550 WEBB AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3930
Practice Address - Country:US
Practice Address - Phone:732-406-5985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216016173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZXVT1Medicare PIN
NYH56492Medicare UPIN