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General NPI Number Information
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NPI Number | 1912178385
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Entity Type | Organization
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Legal Business Name | JOSEPH TAVERNI M.D. P.C.
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 1000 NORTHERN BLVD SUITE 360
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City | GREAT NECK
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State | NY
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Zip | 11021-5312
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Country | US
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Telephone | 516-482-7747
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Fax | 516-482-7748
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Provider Business Mailing Address
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Address Line | 1000 NORTHERN BLVD SUITE 360
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City | GREAT NECK
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State | NY
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Zip | 11021-5312
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Country | US
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Telephone | 516-482-7747
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Fax | 516-482-7748
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. JOSEPH PATRICK TAVERNI
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Credential | M.D.
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Telephone | 516-482-7747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 201665
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License Number State | NY
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