Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 132804 | NY |
NPI | 1073506713 |
---|---|
Provider Name | Dr. Edwin C Tan |
First Address | New York, NY 10013-4135 |
Second Address | Flushing, NY 11354-6533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 02/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00377633 | (05) | NY |