Provider Demographics
NPI:1245363415
Name:TAVERNI, JOSEPH PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:TAVERNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201665208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990183Medicaid
NY01990183Medicaid
NYH20012Medicare UPIN