Provider Demographics
NPI:1386645125
Name:TATZ, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:TATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:95 GRASSLANDS RD
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1533
Mailing Address - Country:US
Mailing Address - Phone:914-493-7513
Mailing Address - Fax:914-493-1281
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1646
Practice Address - Country:US
Practice Address - Phone:914-493-7513
Practice Address - Fax:914-493-1281
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2205422080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206031Medicaid
CT003138329Medicaid
NYI29542Medicare UPIN
NY02206031Medicaid
NY25R14EA201Medicare PIN