Healthcare Provider Details

I. General information

NPI: 1114185915
Provider Name (Legal Business Name): CHEE CHUN TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 5
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

19 DAVIS AVE FL 5
NEPTUNE NJ
07753-4488
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4268
  • Fax: 732-776-3178
Mailing address:
  • Phone: 732-776-4268
  • Fax: 732-776-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA10894600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: