Provider Demographics
NPI:1063855435
Name:TIGA PEDIATRICS PC
Entity type:Organization
Organization Name:TIGA PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORUWARIYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-881-8999
Mailing Address - Street 1:PO BOX 672170
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-0803
Mailing Address - Country:US
Mailing Address - Phone:718-881-8999
Mailing Address - Fax:718-881-1984
Practice Address - Street 1:3510 BAINBRIDGE AVE
Practice Address - Street 2:S5
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1409
Practice Address - Country:US
Practice Address - Phone:718-881-8999
Practice Address - Fax:718-881-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209367173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01810333Medicaid
NY209367OtherNYS LICENSE