Provider Demographics
NPI:1811375579
Name:NANDANI TARUN, TANVI (MD)
Entity type:Individual
Prefix:
First Name:TANVI
Middle Name:
Last Name:NANDANI TARUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HALLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1244
Mailing Address - Country:US
Mailing Address - Phone:631-828-3036
Mailing Address - Fax:631-828-3037
Practice Address - Street 1:815 HALLOCK AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1244
Practice Address - Country:US
Practice Address - Phone:631-828-3036
Practice Address - Fax:631-828-3037
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN21200207R00000X
ARE-13036207R00000X, 207RN0300X
NY328776207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine