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NPI Code Detail

MEDICARE: JACQUELINE BANGAYAN-TAN RN

MEDICARE: JACQUELINE BANGAYAN-TAN RN
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
1163W00000XRegistered Nurse438863NY

General Provider Information

NPI Number : 1528460649
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE BANGAYAN-TAN RN
Provider Business Mailing Address
First Line : 50 BAY ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2511
Country : US
Telephone Number : 718-447-7740
Fax Number : 718-420-1539
Provider Business Practice Location Address
First Line : 50 BAY ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2511
Country : US
Telephone Number : 718-447-7740
Fax Number : 718-420-1539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2014
Last Update Date : 09/19/2014

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