Healthcare Provider Details

I. General information

NPI: 1245409747
Provider Name (Legal Business Name): ELIZABETH ANN TANG PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CUDZIL

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 N BUFFALO ST
ORCHARD PARK NY
14127-1842
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-656-4805
  • Fax: 716-250-5927
Mailing address:
  • Phone: 716-630-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.005072
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: