Provider Demographics
NPI:1649403874
Name:TATEOSIAN, MARIANNE W (DO)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:W
Last Name:TATEOSIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:W
Other - Last Name:GOBRIAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
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:631-444-0650
Mailing Address - Fax:631-638-4170
Practice Address - Street 1:500 COMMACK RD STE 105
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5020
Practice Address - Country:US
Practice Address - Phone:631-632-9510
Practice Address - Fax:631-216-8319
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI681362084P0804X
390200000X
NY268594-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty