MEDICARE: TARUN WASIL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	222768	NY

General Provider Information

NPI Number	:	1710949862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARUN WASIL MD

Provider Business Mailing Address
First Line	:	1500 ROUTE 112 STE 101
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8054
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	317-510-5066

Provider Business Practice Location Address
First Line	:	1 DELAWARE DR STE 105
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1116
Country	:	US
Telephone Number	:	516-336-5255
Fax Number	:	631-751-0506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	12/02/2021

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