Provider Demographics
NPI:1487657649
Name:TUCKMAN, RICHARD
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TUCKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ANDREA DR
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1905
Mailing Address - Country:US
Mailing Address - Phone:631-941-4044
Mailing Address - Fax:
Practice Address - Street 1:STUDENT HEALTH SERVICE, STONY BROOK UNIVERSITY
Practice Address - Street 2:1 STADIUM ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3191
Practice Address - Country:US
Practice Address - Phone:631-632-6171
Practice Address - Fax:631-632-6936
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine