Provider Demographics
NPI:1194194951
Name:RALLIS, TENA MARIA (MD)
Entity type:Individual
Prefix:
First Name:TENA
Middle Name:MARIA
Last Name:RALLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3245
Mailing Address - Country:US
Mailing Address - Phone:212-675-5847
Mailing Address - Fax:275-675-5800
Practice Address - Street 1:67 PERRY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3245
Practice Address - Country:US
Practice Address - Phone:212-675-5847
Practice Address - Fax:212-675-5800
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265089207N00000X
NY323244207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400281897Medicare PIN