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General NPI Number Information
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NPI Number | 1386922359
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Entity Type | Individual
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Provider Name | JESSICA MON CHIN-TAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 14205 ROOSEVELT AVE UNIT 112
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City | FLUSHING
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State | NY
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Zip | 11354-1135
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Country | US
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Telephone | 646-653-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 14205 ROOSEVELT AVE APT 112
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City | FLUSHING
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State | NY
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Zip | 11354-6005
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Country | US
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Telephone | 917-903-9469
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Fax | 646-846-3283
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 274560
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License Number State | NY
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