Provider Demographics
NPI:1568601102
Name:TANG, AILEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 113TH ST
Mailing Address - Street 2:APT 3B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5574
Mailing Address - Country:US
Mailing Address - Phone:347-268-2664
Mailing Address - Fax:
Practice Address - Street 1:7520 113TH ST
Practice Address - Street 2:APT 3B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5574
Practice Address - Country:US
Practice Address - Phone:347-268-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15068-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist