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General NPI Number Information
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NPI Number | 1417300112
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Entity Type | Individual
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Provider Name | CHIN CHENG TAI
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Gender | Male
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 49 PETER RD STE 3
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City | SOUTHBURY
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State | CT
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Zip | 06488-2681
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Country | US
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Telephone | 860-590-9592
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Fax |
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Provider Business Mailing Address
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Address Line | 58 OVERTON FARM RD
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City | SOUTHBURY
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State | CT
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Zip | 06488-2403
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Country | US
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Telephone | 917-434-1674
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Fax | 860-413-0963
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 307846
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 9385
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License Number State | CT
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