Provider Demographics
NPI:1235185521
Name:TRAN, DE CONG (DPM)
Entity Type:Individual
Prefix:
First Name:DE
Middle Name:CONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33-45 94 STREET
Mailing Address - Street 2:APT 1 J
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33-45 94 STREET
Practice Address - Street 2:APT 1 J
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1943
Practice Address - Country:US
Practice Address - Phone:718-429-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN05850213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVO3322Medicare UPIN
NY06906Medicare PIN
NY5459270001Medicare NSC
NYPJ7111Medicare PIN