Provider Demographics
NPI:1700026960
Name:TANG, SUSAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 44TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VILSECK HEALTH CLINIC
Practice Address - Street 2:APO AE
Practice Address - City:VILSECK
Practice Address - State:BAVARIA
Practice Address - Zip Code:09112
Practice Address - Country:DE
Practice Address - Phone:314-476-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0099721363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical