Healthcare Provider Details

I. General information

NPI: 1235823451
Provider Name (Legal Business Name): TIMMI MARIE TAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

IV. Provider business mailing address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-1818
  • Fax: 212-271-7225
Mailing address:
  • Phone: 718-215-1818
  • Fax: 212-271-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number343384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: