Provider Demographics
NPI:1427472182
Name:TIWARI, TAJDHARY (MD)
Entity type:Individual
Prefix:DR
First Name:TAJDHARY
Middle Name:
Last Name:TIWARI
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 1:10923 111TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1015
Mailing Address - Country:US
Mailing Address - Phone:347-385-6059
Mailing Address - Fax:
Practice Address - Street 1:10923 111TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1015
Practice Address - Country:US
Practice Address - Phone:347-385-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0699207R00000X
KY51500207P00000X
PAMD461755207R00000X, 207P00000X
NY281938207P00000X
WV26834207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine