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General NPI Number Information
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NPI Number | 1992134944
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Entity Type | Individual
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Provider Name | TERESA TAN RN
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Gender | Female
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Dates
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Enumeration Date | 11/09/2013
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Last Update Date | 11/09/2013
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Provider Practice Location Address
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Address Line | 1809 NOSTRAND AVE 2ND FLOOR SUITE 1
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City | BROOKLYN
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State | NY
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Zip | 11226-7181
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Country | US
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Telephone | 718-421-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 147-45 69TH ROAD 2ND FL
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City | FLUSHING
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State | NY
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Zip | 11367
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Country | US
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Telephone | 718-570-7341
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 668914
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License Number State | NY
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