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1376862821

NPI Code Detail

MEDICARE: MIRANDA TAN DO

MEDICARE: MIRANDA TAN DO

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	207RP1001X	Pulmonary Disease Physician	270140	NY
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	270140	NY
3	207R00000X	Internal Medicine Physician	270140	NY
4	207RP1001X	Pulmonary Disease Physician	20A20250	CA
5	207R00000X	Internal Medicine Physician	20A20250	CA
6	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	20A20250	CA
7	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	270140	NY

General Provider Information

NPI Number	:	1376862821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA TAN DO

Provider Business Mailing Address
First Line	:	622 W 168TH ST PH 859
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-305-7591
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 W 168TH ST PH 859
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-305-7591
Fax Number	:

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

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	04/13/2026

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Directions to “ MIRANDA TAN DO” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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