MEDICARE: DR. BENG JIT TAN MD, PHD

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	208800000X	Urology Physician	231029	NY
2	208D00000X	General Practice Physician	231029	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P010231029	OTHER	NY	MONROE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	40403006189	OTHER	NY	FIDELIS
4	928140001	OTHER	NY	HEALTH NOW
5	P010231029	OTHER	NY	FAMILY HEALTH PLUS
6	27164801	OTHER	NY	UNIVERA
7	1000741	OTHER	NY	GHI
8	MDJ211	OTHER	NY	PREFERRED CARE
9	1913021	OTHER	NY	IHA
10	7238658	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1922096627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENG JIT TAN MD, PHD

Provider Business Mailing Address
First Line	:	346 GRAND AVE
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2541
Country	:	US
Telephone Number	:	607-729-8156
Fax Number	:	607-729-2209

Provider Business Practice Location Address
First Line	:	30 HARRISON ST
Second Line	:	SUITE 460
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2161
Country	:	US
Telephone Number	:	607-763-8101
Fax Number	:	607-763-8049

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/21/2017

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