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General NPI Number Information
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NPI Number | 1336224203
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Entity Type | Individual
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Provider Name | BLANCA A TAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3342 KENNEDY BLVD.
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City | JERSEY
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State | NJ
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Zip | 07307-4233
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Country | US
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Telephone | 201-653-8999
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Fax | 201-653-4477
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Provider Business Mailing Address
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Address Line | 120 JOCKEY HOLLOW WAY
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City | UNION
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State | NJ
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Zip | 07083-4157
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Country | US
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Telephone | 908-687-3725
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Fax | 908-686-5258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA03544400
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License Number State | NJ
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