Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 153174 | NY |
NPI | 1013339894 |
---|---|
Provider Name | Dr. George Walter Tyson |
First Address | Setauket, NY 11733-1526 |
Second Address | Setauket, NY 11733-1526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2014 |
Last Update Date | 02/08/2016 |