Provider Demographics
NPI:1457442162
Name:TAN, MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:MENLO PARK STATION
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08818-2029
Mailing Address - Country:US
Mailing Address - Phone:732-494-1444
Mailing Address - Fax:
Practice Address - Street 1:2 LINCOLN HIGHWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-494-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61486207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6532004Medicaid
NJ777457Medicare ID - Type Unspecified
NJG01039Medicare UPIN