Provider Demographics
NPI:1831115179
Name:TAN, ANGELITO DURANO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELITO
Middle Name:DURANO
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 1:2000 NORTH VILLAGE AVENUE
Mailing Address - Street 2:STE 202
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-536-5511
Mailing Address - Fax:516-536-5579
Practice Address - Street 1:2000 NORTH VILLAGE AVENUE
Practice Address - Street 2:STE 202
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-536-5511
Practice Address - Fax:516-536-5579
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1267052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00268406Medicaid
NYC08622Medicare UPIN
NY00268406Medicaid