=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861183816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TANER AYDIN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2023
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 MONTAUK HWY STE S
-----------------------------------------------------
City | WEST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11795-4420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-707-3780
-----------------------------------------------------
Fax | 631-203-2071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 MONTAUK HWY STE S
-----------------------------------------------------
City | WEST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11795-4420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-707-3780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL / OWNER
-----------------------------------------------------
Name | TANER AYDIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-252-4421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------