Provider Demographics
NPI:1457525701
Name:TANNOUS, HENRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:TANNOUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-1820
Mailing Address - Fax:631-444-8963
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1820
Practice Address - Fax:631-444-8963
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY239983208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02961613Medicaid
NY48X84MW321Medicare Oscar/Certification