Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 248412 | NY |
Y | 208600000X | Surgeon | 248412 | NY |
NPI | 1013182591 |
---|---|
Provider Name | Lawrence J Tarasuk |
First Address | Southampton, NY 11969-2340 |
Second Address | Southampton, NY 11968-5087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2008 |
Last Update Date | 02/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02978994 | (05) | NY |
248412 | LICENSE (01) | NY |