Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DN17755 | FL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 054229-1 | NY |
NPI | 1275556425 |
---|---|
Provider Name | Dr. Mario Tuchman |
First Address | New York, NY 10021-5137 |
Second Address | New York, NY 10016-0941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 09/03/2017 |