MEDICARE: PAO-JU TSENG NURSE PRACTITIONER

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	363LP2300X	Primary Care Nurse Practitioner	F308370-1	NY

General Provider Information

NPI Number	:	1386163012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAO-JU TSENG NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	4199 MAIN ST STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5164
Country	:	US
Telephone Number	:	718-961-1897
Fax Number	:	718-961-1897

Provider Business Practice Location Address
First Line	:	4199 MAIN ST STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5164
Country	:	US
Telephone Number	:	718-961-1897
Fax Number	:	718-766-9749

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	08/15/2024

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