Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 202867 | NY |
N | 111NI0900X | Internist | 202867 | NY |
Y | 207RN0300X | Nephrologist | 202867 | NY |
NPI | 1053343731 |
---|---|
Provider Name | Reynaldo Go Tan |
First Address | Brooklyn, NY 11228-2805 |
Second Address | Brooklyn, NY 11228-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 29/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01609067 | (05) | NY |
G08408 | (02) | NY |