Provider Demographics
NPI:1407899867
Name:TANG - CHAN, JENNY (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:TANG - CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7814 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3516
Mailing Address - Country:US
Mailing Address - Phone:917-365-8083
Mailing Address - Fax:
Practice Address - Street 1:15 W 65TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6601
Practice Address - Country:US
Practice Address - Phone:212-769-6313
Practice Address - Fax:212-769-7825
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210935-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG78417Medicare UPIN
NY43C121Medicare ID - Type UnspecifiedPROVIDER NUMBER