Healthcare Provider Details

I. General information

NPI: 1235153784
Provider Name (Legal Business Name): JOSEPH S TAMBURRINO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BRENTWOOD ROAD
BAYSHORE NY
11706
US

IV. Provider business mailing address

23 MEADOW WAY
EASTPORT NY
11941
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-8100
  • Fax: 631-665-2227
Mailing address:
  • Phone: 631-666-8100
  • Fax: 631-665-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN002519-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: