MEDICARE: DR. VINAY MANOHAR TAK MD, FRCS(ED), FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	2380341	NY
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	155057	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083694541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINAY MANOHAR TAK MD, FRCS(ED), FACS

Provider Business Mailing Address
First Line	:	STONY BROOK HOSPITAL
Second Line	:	100 NICHOLS ROAD
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-2034
Fax Number	:	631-444-8947

Provider Business Practice Location Address
First Line	:	STONY BROOK HOSPITAL
Second Line	:	100 NICHOLS ROAD
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-2034
Fax Number	:	631-444-8947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	05/07/2019

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