Provider Demographics
NPI:1821086737
Name:TAN, PATRICIA TING (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:TING
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1158 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4205
Mailing Address - Country:US
Mailing Address - Phone:516-252-9262
Mailing Address - Fax:516-868-0685
Practice Address - Street 1:1158 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-252-9262
Practice Address - Fax:516-868-0685
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190003208100000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579060Medicaid
NY01579060Medicaid
NY353031Medicare PIN