Provider Demographics
NPI:1669903225
Name:TAVERNIER, FELIX BERNARD (MD)
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:BERNARD
Last Name:TAVERNIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-637-6003
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY, LEVEL 2-749
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7025
Practice Address - Country:US
Practice Address - Phone:631-444-2224
Practice Address - Fax:631-444-3419
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program