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General NPI Number Information
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NPI Number | 1538610522
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Entity Type | Organization
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Legal Business Name | CREST MEDICAL CARE, PC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 2520 146TH ST
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City | FLUSHING
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State | NY
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Zip | 11354-1329
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Country | US
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Telephone | 347-341-0365
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Fax | 718-886-0644
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Provider Business Mailing Address
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Address Line | 13336 41ST RD SUITE 2G
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City | FLUSHING
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State | NY
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Zip | 11355-3666
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Country | US
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Telephone | 347-341-0365
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Fax | 718-886-0644
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Authorized Official
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Title or Position | OWNER
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Name | DR. WU TAN
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Credential | M.D.
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Telephone | 347-341-0365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 267436-1
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License Number State | NY
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