Healthcare Provider Details

I. General information

NPI: 1689069452
Provider Name (Legal Business Name): ARIEL TASSY NUNEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIEL TASSY MD

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD SUITE 108
NEW HYDE PARK NY
11042
US

IV. Provider business mailing address

4134 CRESCENT ST APT 3M
LONG ISLAND CITY NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-3270
  • Fax: 516-465-5299
Mailing address:
  • Phone: 631-902-7311
  • Fax: 516-465-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number285685
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: