Provider Demographics
NPI:1912401142
Name:TANZI, MATTHEW VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:VINCENT
Last Name:TANZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 NICOLLS RD
Mailing Address - Street 2:STONY BROOK MEDICINE, DEPT OF EM, HSC LEVEL 4, RM 050
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-2478
Mailing Address - Fax:631-444-3919
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:STONY BROOK MEDICINE, DEPT OF EM, HSC LEVEL 4, RM 050
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-2478
Practice Address - Fax:631-444-3919
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY309203207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program