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General NPI Number Information
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NPI Number | 1881221570
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Entity Type | Individual
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Provider Name | ALVERA TABBASUM MD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 301 E MAIN ST
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City | BAY SHORE
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State | NY
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Zip | 11706-8408
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Country | US
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Telephone | 631-552-9664
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Fax |
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Provider Business Mailing Address
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Address Line | 100 NICOLLS RD RM 20
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City | STONY BROOK
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State | NY
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Zip | 11790-3407
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Country | US
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Telephone | 631-444-7411
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 324002
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License Number State | NY
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