Provider Demographics
NPI:1700178969
Name:TAMDJI, NATACHA M (DO)
Entity type:Individual
Prefix:DR
First Name:NATACHA
Middle Name:M
Last Name:TAMDJI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1436 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1405
Mailing Address - Country:US
Mailing Address - Phone:929-210-6550
Mailing Address - Fax:929-210-6551
Practice Address - Street 1:1436 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1405
Practice Address - Country:US
Practice Address - Phone:929-210-6550
Practice Address - Fax:929-210-6551
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY256370-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
NY00695941Medicaid
NY331944Medicare Oscar/Certification