Supoj Tanchajja, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

NY129075 Issued in NY

Practice address

338 Court St
Brooklyn, NY 11231-4334

Phone

(718) 748-4603

Fax

(718) 625-3189

NPI assigned

Sep 13, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: supojtanchajja@mai.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maimonides Faculty Practice Plan

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1053344846
  Medicare reassignment NPD
• Maimonides Medical Center General Surgery FPP

  • Surgery Physician
  • Brooklyn, NY
  • NPI 1235386905
  Medicare reassignment NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD
• State of New York

  dba Suny DMC @ Lich-Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Brooklyn, NY
  • NPI 1639477979
  NPD (past)
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  NPD (past)
• Suny Health Science Center at Brooklyn

  dba Suny DMC@Lich-Urology

  • Urology Physician
  • Brooklyn, NY
  • NPI 1104124379
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471478400000",
    "number": "1245225549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 82ND ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112093810",
            "telephone_number": "718-748-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 COURT ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112314334",
            "telephone_number": "718-748-4603",
            "fax_number": "718-625-3189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANCHAJJA",
        "first_name": "SUPOJ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2016-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "NY129075",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NY",
            "license": "NY129075",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00487449",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Takaki Tanamoto, M.D.
• Danielle Tanamy, MASTER'S DEGREE
• Sherry Tanamy, MSSPED
• Ana Tanase-Teaca, M.D.
• Priyanka A Tanavde, PT, DPT
• Ofri Tanchelson
• Kelsey M Tandon, MD
• Myosha Tane, LMSW
• Cheryl Tanenbaum
• Eden Tanenbaum, LMSW

• Surgery Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.