Provider Demographics
NPI:1043707003
Name:TASSAVOR, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TASSAVOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TEN ROD HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2849
Mailing Address - Country:US
Mailing Address - Phone:212-659-9530
Mailing Address - Fax:
Practice Address - Street 1:820 2ND AVE RM 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4534
Practice Address - Country:US
Practice Address - Phone:212-661-3376
Practice Address - Fax:212-661-3366
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11789400207ND0101X
NY323010-01207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery