Basic Information
| Provider Information | |||||||||
| NPI: | 1598717704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAWIL | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6540 | ||||||||
| Address2: | CHURCH STREET STATION | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 102496540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189467557 | ||||||||
| FaxNumber: | 7189469680 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 BRIGHTON BEACH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112358002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189467557 | ||||||||
| FaxNumber: | 7189469680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 172721 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 172721 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 01378638 | 05 | NY | MEDICAID |