Provider Demographics
NPI:1861183816
Name:TANER AYDIN MD PLLC
Entity type:Organization
Organization Name:TANER AYDIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANER
Authorized Official - Middle Name:
Authorized Official - Last Name:AYDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-252-4421
Mailing Address - Street 1:500 MONTAUK HWY STE S
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4420
Mailing Address - Country:US
Mailing Address - Phone:631-707-3780
Mailing Address - Fax:
Practice Address - Street 1:500 MONTAUK HWY STE S
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4420
Practice Address - Country:US
Practice Address - Phone:631-707-3780
Practice Address - Fax:631-203-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY313530OtherLICENSE