Provider Demographics
NPI:1598454910
Name:KORGA, TESFALEM ISRAEL (MD)
Entity type:Individual
Prefix:DR
First Name:TESFALEM
Middle Name:ISRAEL
Last Name:KORGA
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 1:3636 WALDO AVENUE
Mailing Address - Street 2:APT 8B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:914-387-2521
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 210TH STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-4321
Practice Address - Fax:718-920-8543
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-11-15
Deactivation Date:2023-12-07
Deactivation Code:
Reactivation Date:2024-11-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program