Basic Information
| Provider Information | |||||||||
| NPI: | 1063411502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENET | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 FRANCIS LEWIS BLVD | ||||||||
| Address2: | SUITE L3A | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113613028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187170238 | ||||||||
| FaxNumber: | 7187170265 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 NORTHERN BOULEVARD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | MANHASSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110303043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166274330 | ||||||||
| FaxNumber: | 5164672557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 156318 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00953388 | 05 | NY | MEDICAID |