MEDICARE: DR. SUSAN TANG M.D.

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	207Q00000X	Family Medicine Physician	115472	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
2	008761	OTHER	NY	GHI

General Provider Information

NPI Number	:	1972645018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN TANG M.D.

Provider Business Mailing Address
First Line	:	19010 RADNOR RD
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-1023
Country	:	US
Telephone Number	:	718-740-0163
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-4206
Country	:	US
Telephone Number	:	718-731-0704
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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