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General NPI Number Information
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NPI Number | 1801082219
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Entity Type | Organization
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Legal Business Name | ANGELITO D. TAN, M.D., PC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 2000 N VILLAGE AVE STE 202
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-1078
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Country | US
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Telephone | 516-536-5511
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Fax | 516-536-5579
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Provider Business Mailing Address
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Address Line | 2000 N VILLAGE AVE STE 202
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-1078
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Country | US
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Telephone | 516-536-5511
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Fax | 516-536-5579
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGELITO DURANO TAN
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Credential | M.D.
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Telephone | 516-536-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 126705
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License Number State | NY
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