Provider Demographics
NPI:1275135287
Name:TAN, CATHERINE SUSAN
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUSAN
Last Name:TAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 FOCH BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1010
Mailing Address - Country:US
Mailing Address - Phone:516-606-9640
Mailing Address - Fax:
Practice Address - Street 1:710 FOCH BLVD
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1010
Practice Address - Country:US
Practice Address - Phone:516-606-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant