KEVIN L TACK (NPI# 1871599605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871599605 |
| Entity Type | Individual |
| Full Name | KEVIN L TACK |
| Credential | M.D. |
| Practice Address |
1615 Northern Blvd Manhasset NY 11030-3033 |
| Practice Telephone | 5166273717 |
| Practice Fax Number | 5168698625 |
| Mailing Telephone | 5166273717 |
| Mailing Fax Number | 5168698625 |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2009-12-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
180244 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
1615 NORTHERN BLVD |
| City | MANHASSET |
| State | NY |
| Zip Code | 11030-3033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427054584 | Thomas A Nicosia | Internal Medicine | 1615 Northern Blvd, Manhasset, NY 11030 | 2005-06-23 |
| 1861974438 | Carson Jean Potash | Physical Therapist | 1615 Northern Blvd, #202, Manhasset, NY 11030 | 2018-08-30 |
| 1265811483 | Kiho Lee | Acupuncturist | 1615 Northern Blvd, Suite 202, Manhasset, NY 11030-3008 | 2015-05-20 |
| 1144659749 | Mount Sinai School of Medicine | Internal Medicine | 1615 Northern Blvd, Manhasset, NY 11030-3008 | 2013-11-04 |
| 1457601403 | Sherry Reill | Nurse Practitioner | 1615 Northern Blvd, Suite 301, Manhasset, NY 11030-3008 | 2012-09-18 |
| 1225301245 | Judah Philip Guy | Internal Medicine | 1615 Northern Blvd, Suite Gr5, Manhasset, NY 11030-3008 | 2012-02-22 |
| 1891062469 | Andrew James Ciancimino | Internal Medicine | 1615 Northern Blvd, Manhasset, NY 11030-3008 | 2011-11-25 |
| 1215215355 | Jessica Newburger | Dermatology | 1615 Northern Blvd, Manhasset, NY 11030-3008 | 2011-07-22 |
| 1205161635 | Katherine Frangos Audiology, P.C. | Clinic/Center | 1615 Northern Blvd, Suite 201, Manhasset, NY 11030-3033 | 2009-10-02 |
| 1356521322 | Katherine Anastasia Frangos | Audiologist | 1615 Northern Blvd, Suite 201, Manhasset, NY 11030-2142 | 2007-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831754126 | Diana Fox | Registered Nurse | 330 Community Drive, Manhasset, NY 11030 | 2019-05-02 |
| 1215470257 | Melissa Fackler | Registered Nurse | 1350 Northern Blvd Ste 202, Manhasset, NY 11030 | 2016-11-23 |
| 1821443391 | Sarah Javdan | Family Medicine | 800 Community Dr Ste 206, Manhasset, NY 11030 | 2016-05-03 |
| 1891167458 | Stacie Thaw Lcsw Pllc | Social Worker | 115 Park Ave., Manhasset, NY 11030 | 2015-10-22 |
| 1538547971 | Aarti Kumar | Podiatrist | 535 Plandome Rd # 2, Manhasset, NY 11030 | 2015-05-18 |
| 1073933586 | Rachel Durante | Occupational Therapist | 600 Community Drive, Manhasset, NY 11030 | 2014-04-23 |
| 1831436435 | Anesthesia Care, P.C. | General Practice | 565 Plandome Road, Manhasset, NY 11030 | 2013-01-16 |
| 1821350091 | Sylvia Yoonsun Kim | Pharmacist | 139 Vanderbilt Ave, Manhasset, NY 11030 | 2012-06-13 |
| 1699062588 | Rod Stern | Dentist | 444 Community Dr Ste 201, Manhasset, NY 11030 | 2011-06-30 |
| 1558654798 | Alexandria Pace Kress | Speech-Language Pathologist | 31 Circle Dr, Manhasset, NY 11030 | 2011-05-20 |
| Find all providers in zip 11030 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770752594 | Katherine S Freeman | Internal Medicine | 1155 Northern Blvd Ste 300, Manhasset, NY 11030-3041 | 2008-02-26 |
| 1790845840 | Bethany Devito | Internal Medicine | Nsuh Dept. of Medicine Gastroenterology, 300 Community Drive, Manhasset, NY 11030 | 2006-12-11 |
| 1063572113 | Bernard Stark | Internal Medicine | Nsuh Dept of Medicine Division of Gastroenterology, 300 Community Drive, Manhasset, NY 11030 | 2006-12-11 |
| 1912078304 | David Bernstein | Internal Medicine | Nsuh-dept of Med Div of Gastro, 300 Community Drive, Manhasset, NY 11030 | 2006-11-10 |
| 1124198569 | Edna Khodadadian | Internal Medicine | Nsuh - Dept of Medicine, 300 Community Drive, Manhasset, NY 11030 | 2006-11-09 |
| 1144863051 | Elishia Kathleen Crumwell-mack | Internal Medicine | 400 Community Dr, Manhasset, NY 11030-3815 | 2019-10-23 |
| 1174866040 | Ben Lin Da | Internal Medicine | 400 Community Dr, Manhasset, NY 11030-3815 | 2013-03-29 |
| 1376824516 | Christian Kuntzen | Internal Medicine | 400 Community Dr, Manhasset, NY 11030-3815 | 2011-09-01 |
| 1457676090 | Chun Kit Hung | Internal Medicine | 300 Community Dr, Manhasset, NY 11030-3816 | 2010-04-06 |
| 1386873487 | Great Neck Gastro, Pllc | Internal Medicine | 1155 Northern Blvd, Suite 360, Manhasset, NY 11030-3040 | 2009-07-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.