Healthcare Provider Details

I. General information

NPI: 1407796618
Provider Name (Legal Business Name): ADITA TAMANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 NORTHERN BLVD
JACKSON HEIGHTS NY
11372-1345
US

IV. Provider business mailing address

135 MINEOLA BLVD FL 2
MINEOLA NY
11501-3917
US

V. Phone/Fax

Practice location:
  • Phone: 917-310-3371
  • Fax: 516-938-1554
Mailing address:
  • Phone: 516-206-2437
  • Fax: 516-938-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359370
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: