Provider Demographics
NPI:1073671384
Name:TASSINARI, PATRICIA J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:TASSINARI
Suffix:
Gender:F
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:POB 528
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-0528
Mailing Address - Country:US
Mailing Address - Phone:516-827-2727
Mailing Address - Fax:516-827-2736
Practice Address - Street 1:750 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5017
Practice Address - Country:US
Practice Address - Phone:516-827-2727
Practice Address - Fax:516-827-2736
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07146Medicare UPIN
NY2453DHMedicare ID - Type Unspecified
NYA300058687Medicare PIN