Provider Demographics
NPI:1538255401
Name:TEJERA, CARLOS ALBERTO (MD, FAPA)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:TEJERA
Suffix:
Gender:M
Credentials:MD, FAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TERREHANS LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6326
Mailing Address - Country:US
Mailing Address - Phone:516-364-4749
Mailing Address - Fax:
Practice Address - Street 1:444 COMMUNITY DR
Practice Address - Street 2:SUITE 311
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3820
Practice Address - Country:US
Practice Address - Phone:516-869-1954
Practice Address - Fax:516-869-0673
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1719352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38F971Medicare ID - Type Unspecified
NYE87371Medicare UPIN