Provider Demographics
NPI:1306888490
Name:PINKHASOVA, TAMARA (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:PINKHASOVA
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 1:2675 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3745
Mailing Address - Country:US
Mailing Address - Phone:718-365-3488
Mailing Address - Fax:
Practice Address - Street 1:2675 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3745
Practice Address - Country:US
Practice Address - Phone:718-365-3488
Practice Address - Fax:347-275-5157
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY80S591Medicare ID - Type Unspecified
NYH80889Medicare UPIN