=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427129071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN LIZHONG TAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 02/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5010 STATE HIGHWAY 30 SUITE 204
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-842-8185
-----------------------------------------------------
Fax | 518-842-8189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5010 STATE HIGHWAY 30 SUITE 204
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-842-8185
-----------------------------------------------------
Fax | 518-842-8189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 183416
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YX0602X
-----------------------------------------------------
Taxonomy Name | Otolaryngic Allergy Physician
-----------------------------------------------------
License Number | 183416
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------