Provider Demographics
NPI:1912178385
Name:JOSEPH TAVERNI M.D. P.C.
Entity Type:Organization
Organization Name:JOSEPH TAVERNI M.D. P.C.
Other - Org Name:JMS SPORTS MEDICINE & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:TAVERNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-482-7747
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-482-7747
Mailing Address - Fax:516-482-7748
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-482-7747
Practice Address - Fax:516-482-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201665208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW39341OtherMEDICARE ID - GROUP ID