Healthcare Provider Details

I. General information

NPI: 1326071036
Provider Name (Legal Business Name): STEVEN TUZINKIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E MAIN ST SUITE 12
BAY SHORE NY
11706-8418
US

IV. Provider business mailing address

375 E MAIN ST SUITE 12
BAY SHORE NY
11706-8418
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-5620
  • Fax: 631-666-4668
Mailing address:
  • Phone: 631-666-5620
  • Fax: 631-666-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number214933
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2351866
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: