MEDICARE: DR. PHOEBE TIN TIN MA DMD

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	122300000X	Dentist	047792	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427047406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHOEBE TIN TIN MA DMD

Provider Business Mailing Address
First Line	:	98 E. BROADWAY
Second Line	:	SUITE 501
City	:	NEW YORK
State	:	NY
Zip	:	10002-7181
Country	:	US
Telephone Number	:	212-227-4349
Fax Number	:	212-227-3216

Provider Business Practice Location Address
First Line	:	98 E. BROADWAY
Second Line	:	SUITE 501
City	:	NEW YORK
State	:	NY
Zip	:	10002-7181
Country	:	US
Telephone Number	:	212-227-4349
Fax Number	:	212-227-3216

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	03/04/2015

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