Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00569700 | NJ |
NPI | 1013397983 |
---|---|
Provider Name | Lei Tang |
First Address | Hamilton, NJ 08690-3414 |
Second Address | Hamilton, NJ 08690-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 17/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0634891 | (05) | NJ |