Healthcare Provider Details

I. General information

NPI: 1740804384
Provider Name (Legal Business Name): ALLISON SY TAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BAHR CIR
VERONA NJ
07044-3200
US

IV. Provider business mailing address

30 W CENTURY RD STE 235
PARAMUS NJ
07652-1421
US

V. Phone/Fax

Practice location:
  • Phone: 732-694-8862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00566300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: