MEDICARE: MS. IMELDA JOY TAN PT

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	225100000X	Physical Therapist	026567	NY

General Provider Information

NPI Number	:	1659466464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IMELDA JOY TAN PT

Provider Business Mailing Address
First Line	:	501 5TH AVE
Second Line	:	SUITE 1108
City	:	NEW YORK
State	:	NY
Zip	:	10017-6107
Country	:	US
Telephone Number	:	212-661-8480
Fax Number	:	212-661-8481

Provider Business Practice Location Address
First Line	:	501 5TH AVE
Second Line	:	SUITE 1108
City	:	NEW YORK
State	:	NY
Zip	:	10017-6107
Country	:	US
Telephone Number	:	212-661-8480
Fax Number	:	212-661-8481

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	04/01/2012

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