=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154028561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW TANG OD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2023
-----------------------------------------------------
Last Update Date | 02/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 730 ROUTE 304 STE 5
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-300-6782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 730 ROUTE 304 STE 5
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-300-6782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANDREW TANG
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 212-300-6782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------