Individual
TANIA REVOLUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2201 HEMPSTEAD TURNPIKE, EAST MEADOW, NY 11554
(516) 572-6255
Mailing address
1510 HAWKINS AVE, NORTH BALDWIN, NY 11510-1815
(516) 428-7626
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
279585
NY
Other
Enumeration date
10/06/2011
Last updated
08/13/2015
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