Provider Demographics
NPI:1578551214
Name:TAN-CHU, NOREEN (M D)
Entity Type:Individual
Prefix:DR
First Name:NOREEN
Middle Name:
Last Name:TAN-CHU
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 HYLAN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4344
Mailing Address - Country:US
Mailing Address - Phone:718-351-1136
Mailing Address - Fax:718-667-9711
Practice Address - Street 1:2627 HYLAN BLVD STE C
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4344
Practice Address - Country:US
Practice Address - Phone:718-351-1136
Practice Address - Fax:718-667-9711
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579419Medicaid
NY01579419Medicaid
F99268Medicare UPIN
03M461Medicare ID - Type Unspecified