Healthcare Provider Details

I. General information

NPI: 1568456606
Provider Name (Legal Business Name): TSO-JEN HSIAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD SUITE 209
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

100 MANETTO HILL RD SUITE 209
PLAINVIEW NY
11803-1311
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-4550
  • Fax: 516-938-4559
Mailing address:
  • Phone: 516-938-4550
  • Fax: 516-938-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number197490
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: