Provider Demographics
NPI:1598099020
Name:TANG, SHAN (PT)
Entity Type:Individual
Prefix:MISS
First Name:SHAN
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 71ST ST
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1215
Mailing Address - Country:US
Mailing Address - Phone:718-491-1023
Mailing Address - Fax:718-491-1023
Practice Address - Street 1:1038 71ST ST
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1215
Practice Address - Country:US
Practice Address - Phone:718-491-1023
Practice Address - Fax:718-491-1023
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014619-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist