Active NPI
I.a. Tangoren, M.D., P.L.L.C.
- Dermatology Physician
- Syracuse, NY
National Provider Identifier
1265594584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 209386-1
- Legal business name
- I.A. TANGOREN, M.D., P.L.L.C.
- Practice address
- 2949 Erie Blvd E Ste 110
Syracuse, NY 13224-1460 - Phone
- (315) 424-1430
- Fax
- (315) 424-1779
- NPI assigned
- Dec 14, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Tracy E. Barrett-Tangoren, M.D.
- Title
- Practice Administrator
- Phone
- (315) 569-7900
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 209386-1 | NY | Primary |
Addresses
Primary practice location
2949 Erie Blvd E Ste 110
Syracuse, NY 13224-1460
Mailing address
2949 Erie Blvd E Ste 110
Syracuse, NY 13224-1460
Phone (315) 424-1430
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pulmonary Disease Physician
- Syracuse, NY
- NPI 1215932686
-
- Family Nurse Practitioner
- Ithaca, NY
- NPI 1629029384
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040322001093 | NY | Part B Supplier - Clinic/Group Practice | 7517858475 |
Receives reassigned benefits from 5 practitioners Practice locations: Syracuse, NY |
National Provider Directory
National Provider DirectoryLocations
2949 Erie Blvd E
Ste 110
Syracuse, NY 13224
Phone (315) 424-1430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1379980800000",
"number": "1265594584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2949 ERIE BLVD E STE 110",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132241460",
"telephone_number": "315-424-1430",
"fax_number": "315-424-1779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2949 ERIE BLVD E STE 110",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132241460",
"telephone_number": "315-424-1430",
"fax_number": "315-424-1779"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "I.A. TANGOREN, M.D., P.L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-14",
"last_updated": "2013-09-24",
"status": "A",
"authorized_official_last_name": "BARRETT-TANGOREN",
"authorized_official_first_name": "TRACY",
"authorized_official_middle_name": "E.",
"authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
"authorized_official_telephone_number": "315-569-7900",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "NY",
"license": "209386-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.