Healthcare Provider Details

I. General information

NPI: 1568620300
Provider Name (Legal Business Name): TAK YEE TANIA TAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 03/29/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EAST 14TH STREET SUITE 319S
NEW YORK NY
10003-4210
US

IV. Provider business mailing address

310 EAST 14TH STREET SUITE 319S
NEW YORK NY
10003-4210
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-4500
  • Fax: 212-979-4512
Mailing address:
  • Phone: 212-979-4500
  • Fax: 212-979-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA98402
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD436287
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number257879
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA257879
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA257879
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: