MEDICARE: TAE AN CHOI N.P.

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	363LA2200X	Adult Health Nurse Practitioner	305759	NY

General Provider Information

NPI Number	:	1376831966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAE AN CHOI N.P.

Provider Business Mailing Address
First Line	:	10230 66TH RD APT 28C
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7622
Country	:	US
Telephone Number	:	917-755-6179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-5121
Country	:	US
Telephone Number	:	631-979-0922
Fax Number	:

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

Provider Enumeration Date	:	07/15/2011
Last Update Date	:	07/15/2011

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