Provider Demographics
NPI:1639514532
Name:BESONG, DENNIS TAMBE (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:TAMBE
Last Name:BESONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 COMMERCE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3118
Mailing Address - Country:US
Mailing Address - Phone:631-727-1600
Mailing Address - Fax:631-591-3488
Practice Address - Street 1:34 COMMERCE AVE STE 1
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3118
Practice Address - Country:US
Practice Address - Phone:631-727-1600
Practice Address - Fax:631-591-3488
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128732207Q00000X
390200000X
NY306028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program