Provider Demographics
NPI:1194740977
Name:TUCKMAN, DAVID V (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:TUCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-627-8717
Mailing Address - Fax:516-365-1634
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:STE 300
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-627-8717
Practice Address - Fax:516-365-1634
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2156462207X00000X
NY215646207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY648G71Medicare PIN
I39874Medicare UPIN
NYP00454780Medicare PIN