Healthcare Provider Details

I. General information

NPI: 1245223015
Provider Name (Legal Business Name): BERNARD TAWFIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SCHOOL ST SUITE 304
GLEN COVE NY
11542-2548
US

IV. Provider business mailing address

3 SCHOOL ST SUITE 304
GLEN COVE NY
11542-2548
US

V. Phone/Fax

Practice location:
  • Phone: 516-671-0085
  • Fax: 516-671-0272
Mailing address:
  • Phone: 516-671-0085
  • Fax: 516-671-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number115902 1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number115902 1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number115902 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: