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General NPI Number Information
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NPI Number | 1881604601
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Entity Type | Individual
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Provider Name | TOMAS HAVRANEK MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1601 TENBROECK AVE
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City | BRONX
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State | NY
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Zip | 10461-2007
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Country | US
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Telephone | 314-440-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 TENBROECK AVE
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City | BRONX
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State | NY
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Zip | 10461-2007
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Country | US
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Telephone | 314-440-9242
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Fax | 317-977-6777
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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 | 2006034636
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 2006034636
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 216275
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License Number State | NY
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