Healthcare Provider Details

I. General information

NPI: 1639098452
Provider Name (Legal Business Name): JEFFREY TANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SUNSHINE COTTAGE RD
VALHALLA NY
10595-1524
US

IV. Provider business mailing address

711 OLD FARM RD
VALHALLA NY
10595-1511
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-4495
  • Fax:
Mailing address:
  • Phone: 203-512-1991
  • 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 StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: