Provider Demographics
NPI:1821589102
Name:TAN, ZIMRI CIRIACO (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIMRI
Middle Name:CIRIACO
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GREENWICH ST.
Mailing Address - Street 2:APT. 811
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006
Mailing Address - Country:US
Mailing Address - Phone:347-265-8980
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVENUE
Practice Address - Street 2:MLK - RM. 14-106
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-1406
Practice Address - Fax:212-939-2263
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program