Individual
MICHAEL ANDREW TAVILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1131 BROAD STREET, STE 103, SHREWSBURY, NJ 07702
(732) 389-3388
(732) 389-3389
Mailing address
660 WHITE PLAINS RD FL 4, TARRYTOWN, NY 10591-5139
(914) 984-2546
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
25MA06549000
NJ
207YS0012X
Sleep Medicine (Otolaryngology) Physician
25MA06549000
NJ
Other
Enumeration date
10/23/2006
Last updated
04/01/2019
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