Healthcare Provider Details

I. General information

NPI: 1770990459
Provider Name (Legal Business Name): YI-WEI TANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE S428B
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

11201 QUEENS BLVD 18C
FOREST HILLS NY
11375-5566
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-8181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberTANGY4
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: