Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 158418 | NY |
NPI | 1679677892 |
---|---|
Provider Name | Dr. Jeffry Tambor |
First Address | Staten Island, NY 10314-1296 |
Second Address | Staten Island, NY 10306-3523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01925915 | (05) | NY |
A62415 | (02) |