Healthcare Provider Details

I. General information

NPI: 1588462212
Provider Name (Legal Business Name): TINA TIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

27110 GRAND CENTRAL PKWY APT 1X
FLORAL PARK NY
11005-1201
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3000
  • Fax:
Mailing address:
  • Phone: 256-668-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: