MEDICARE: DR. LIN-LAN TANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	MA55250	NJ

General Provider Information

NPI Number	:	1083637896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIN-LAN TANG M.D.

Provider Business Mailing Address
First Line	:	27 MOUNTAIN BLVD
Second Line	:	SUITE 2
City	:	WARREN
State	:	NJ
Zip	:	07059-5605
Country	:	US
Telephone Number	:	908-756-6767
Fax Number	:	908-756-5320

Provider Business Practice Location Address
First Line	:	27 MOUNTAIN BLVD
Second Line	:	SUITE 2
City	:	WARREN
State	:	NJ
Zip	:	07059-5605
Country	:	US
Telephone Number	:	908-756-6767
Fax Number	:	908-756-5320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/14/2007

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