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General NPI Number Information
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NPI Number | 1386828861
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Entity Type | Organization
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Legal Business Name | MARK TAN, M.D., P.C.
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 222 MIDDLE COUNTRY RD SUITE # 312
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-821-5893
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Fax | 631-724-8901
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Provider Business Mailing Address
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Address Line | 222 MIDDLE COUNTRY RD SUITE # 312
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City | SMITHTOWN
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State | NY
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Zip | 11787-2871
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Country | US
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Telephone | 631-821-5893
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Fax | 631-724-8901
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK TAN
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Credential | M.D.
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Telephone | 631-724-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 165674
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License Number State | NY
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