Provider Demographics
NPI:1326444274
Name:TANGIYEV, ARTUR
Entity Type:Individual
Prefix:
First Name:ARTUR
Middle Name:
Last Name:TANGIYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W BROADWAY
Mailing Address - Street 2:SUITE 3N
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3940
Mailing Address - Country:US
Mailing Address - Phone:917-862-5969
Mailing Address - Fax:
Practice Address - Street 1:315 W BROADWAY
Practice Address - Street 2:SUITE 3N
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3940
Practice Address - Country:US
Practice Address - Phone:917-862-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4612423171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor