Individual
LAWRENCE J TARASUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
325 MEETING HOUSE LN, BLDG 2 SUITE 403, SOUTHAMPTON, NY 11968-5087
(631) 283-2100
(631) 283-5731
Mailing address
PO BOX 2340, SOUTHAMPTON, NY 11969-2340
(631) 283-2100
(631) 283-5731
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
248412
NY
208M00000X
Hospitalist Physician
248415
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02978994
—
NY
01
—
248412
LICENSE
NY
Enumeration date
04/25/2008
Last updated
05/02/2009
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