Provider Demographics
NPI:1912082066
Name:TATTELMAN, ELLEN P (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:P
Last Name:TATTELMAN
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 1:3544 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1005
Mailing Address - Country:US
Mailing Address - Phone:718-405-4010
Mailing Address - Fax:718-405-4058
Practice Address - Street 1:MMG - FORDHAM FAMILY PRACTICE
Practice Address - Street 2:ONE FORDHAM PLAZA
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-405-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine