Individual
KEVIN L TACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1615 NORTHERN BLVD, MANHASSET, NY 11030-3033
(516) 627-3717
(516) 869-8625
Mailing address
1615 NORTHERN BLVD, MANHASSET, NY 11030-3033
(516) 627-3717
(516) 869-8625
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
180244
NY
Other
Enumeration date
06/27/2005
Last updated
12/04/2009
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