Healthcare Provider Details

I. General information

NPI: 1083339378
Provider Name (Legal Business Name): TILIS HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 64TH ST
BROOKLYN NY
11204-3448
US

IV. Provider business mailing address

2147 W 7TH ST
BROOKLYN NY
11223-3735
US

V. Phone/Fax

Practice location:
  • Phone: 917-725-1617
  • Fax:
Mailing address:
  • Phone: 917-725-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CHUNG
Title or Position: CEO
Credential: NP
Phone: 917-294-6240