Provider Demographics
NPI:1285739789
Name:EFFENDI, TAHIR (MD)
Entity type:Individual
Prefix:MR
First Name:TAHIR
Middle Name:
Last Name:EFFENDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421A MOE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5100
Mailing Address - Country:US
Mailing Address - Phone:518-272-0028
Mailing Address - Fax:518-272-4859
Practice Address - Street 1:1500 2ND AVE
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2800
Practice Address - Country:US
Practice Address - Phone:518-272-0028
Practice Address - Fax:518-272-4859
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209567207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered174400000XOther Service ProvidersSpecialist