Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 233317-2 | NY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 233317 | NY |
NPI | 1023100542 |
---|---|
Provider Name | Dr. Michael Tunick |
First Address | Endwell, NY 13760-3698 |
Second Address | Endwell, NY 13760-3646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 28/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I15452 | (02) | NY |