Provider Demographics
NPI:1750355434
Name:FUNT, TINA K (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:K
Last Name:FUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SEVENTH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5766
Mailing Address - Country:US
Mailing Address - Phone:516-747-7778
Mailing Address - Fax:516-747-7807
Practice Address - Street 1:229 7TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5766
Practice Address - Country:US
Practice Address - Phone:516-747-7778
Practice Address - Fax:516-747-7807
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167041207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113019075OtherTAX ID NUMBER
NY113019075OtherTAX ID NUMBER
NYE44724Medicare UPIN