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General NPI Number Information
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NPI Number | 1679895676
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Entity Type | Individual
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Provider Name | JIANGCHUAN TAO MD
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Gender | Male
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 1 LODGE LN
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3301
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Country | US
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Telephone | 631-965-3750
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Fax |
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Provider Business Mailing Address
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Address Line | 1 LODGE LN
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3301
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Country | US
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Telephone | 631-965-3750
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 265505
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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