Provider Demographics
NPI:1073932521
Name:TAM, JUSTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINA
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK MEDICINE - DEPARTMENT OF UROLOGY
Mailing Address - Street 2:HSC LEVEL 9 - ROOM 040
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-1910
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UROLOGY
Practice Address - Street 2:HSC T-9 ROOM 040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-6270
Practice Address - Fax:631-444-7620
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAFE610765992088F0040X
NY3187012088F0040X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program