MEDICARE: JULIETA VILLASENOR TANG M.D.

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	115471	NY

General Provider Information

NPI Number	:	1316965106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIETA VILLASENOR TANG M.D.

Provider Business Mailing Address
First Line	:	233 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205
Country	:	US
Telephone Number	:	718-826-3911
Fax Number	:	718-826-3860

Provider Business Practice Location Address
First Line	:	1230 NEPTUNE AVE-CONEY ISLAND CTR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224
Country	:	US
Telephone Number	:	718-615-3200
Fax Number	:	718-615-3340

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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