Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 155057 | MA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 2380341 | NY |
NPI | 1083694541 |
---|---|
Provider Name | Dr. Vinay Manohar Tak |
First Address | Stony Brook, NY 11794-8191 |
Second Address | Stony Brook, NY 11794-8191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02770258 | (05) | NY |
G15903 | (02) | NY |