Healthcare Provider Details

I. General information

NPI: 1538313317
Provider Name (Legal Business Name): TUAN HUNG CAO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OLD MAIN ST
FISHKILL NY
12524
US

IV. Provider business mailing address

17 OLD MAIN ST
FISHKILL NY
12524-1850
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-4991
  • Fax: 845-896-0159
Mailing address:
  • Phone: 845-896-4991
  • Fax: 845-896-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number005007-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: