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General NPI Number Information
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NPI Number | 1265018923
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Entity Type | Individual
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Provider Name | DARCY VINCENT TABOTABO MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 264 W 118TH ST
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City | NEW YORK
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State | NY
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Zip | 10026-1620
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Country | US
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Telephone | 423-298-5688
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Fax |
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Provider Business Mailing Address
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Address Line | 264 W 118TH ST
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City | NEW YORK
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State | NY
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Zip | 10026-1620
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Country | US
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Telephone | 844-692-4692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 331290
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License Number State | NY
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