Provider Demographics
NPI:1235131764
Name:TAVERNA, LUCILLE PATRICIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:PATRICIA
Last Name:TAVERNA
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 1:185 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1431
Mailing Address - Country:US
Mailing Address - Phone:516-766-6550
Mailing Address - Fax:516-678-2822
Practice Address - Street 1:185 MERRICK RD
Practice Address - Street 2:RADIOLOGICAL ASSOCIATES OF LONG ISLAND PC
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1431
Practice Address - Country:US
Practice Address - Phone:516-766-6550
Practice Address - Fax:516-678-2822
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11247412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00380218Medicaid
B13484Medicare UPIN
NY344141Medicare ID - Type Unspecified