Healthcare Provider Details

I. General information

NPI: 1699751057
Provider Name (Legal Business Name): NOLAN DAVID TZOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MAIN ST SUITE 10
HUNTINGTON NY
11743-6922
US

IV. Provider business mailing address

124 MAIN ST SUITE 10
HUNTINGTON NY
11743-6922
US

V. Phone/Fax

Practice location:
  • Phone: 631-629-4770
  • Fax: 631-629-4772
Mailing address:
  • Phone: 631-629-4770
  • Fax: 631-629-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number186571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: