Provider Demographics
NPI:1316926710
Name:TEJANI, FEROZE H (MD)
Entity type:Individual
Prefix:
First Name:FEROZE
Middle Name:H
Last Name:TEJANI
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 1:265 MASON AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-317-1551
Mailing Address - Fax:718-667-6800
Practice Address - Street 1:265 MASON AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-317-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122162208600000X
NJMA40049208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00250124Medicaid
B12882Medicare UPIN
NY00250124Medicaid