Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 203529 | NY |
Y | 111NI0900X | Internist | 203529 | NY |
N | 207RA0401X | Internist - Addiction Medicine | 203529 | NY |
NPI | 1922072313 |
---|---|
Provider Name | Dr. Miguel Antonio Tirado |
First Address | Staten Island, NY 10309-3730 |
Second Address | Staten Island, NY 10309-3730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 30/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G54335 | (02) | NY |