MEDICARE: WEI YAN TAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	225855	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	225855	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1174511000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WEI YAN TAN MD

Provider Business Mailing Address
First Line	:	5618 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3510
Country	:	US
Telephone Number	:	718-439-3284
Fax Number	:	718-439-5029

Provider Business Practice Location Address
First Line	:	5618 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3510
Country	:	US
Telephone Number	:	718-439-3284
Fax Number	:	718-439-5029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	03/27/2015

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Directions to “ WEI YAN TAN MD” Practice Location

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