Healthcare Provider Details

I. General information

NPI: 1659965416
Provider Name (Legal Business Name): TAN'S ACUPUNCTURE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 OLD COUNTRY RD
PLAINVIEW NY
11803-4923
US

IV. Provider business mailing address

553 OLD COUNTRY RD
PLAINVIEW NY
11803-4923
US

V. Phone/Fax

Practice location:
  • Phone: 516-612-3020
  • Fax: 516-612-0321
Mailing address:
  • Phone: 516-612-0320
  • Fax: 516-612-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier006673
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name: TIAN TAN
Title or Position: OWNER
Credential: LAC
Phone: 516-696-8885