Healthcare Provider Details

I. General information

NPI: 1285687269
Provider Name (Legal Business Name): ALI TAMSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MEETING HOUSE LN SUITE #3
SOUTHAMPTON NY
11968-5009
US

IV. Provider business mailing address

196 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5062
US

V. Phone/Fax

Practice location:
  • Phone: 631-726-8268
  • Fax: 631-726-8262
Mailing address:
  • Phone: 229-442-7210
  • Fax: 631-726-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number181348
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number181348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: