Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 159518 | NY |
Y | 207R00000X | Internist | 159518 | NY |
Y | 111NI0900X | Internist | 159518 | NY |
NPI | 1073559001 |
---|---|
Provider Name | John C. Tangeman |
First Address | Cheektowaga, NY 14227-1416 |
Second Address | Cheektowaga, NY 14227-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 19/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B71542 | (02) |