Provider Demographics
NPI:1922096627
Name:TAN, BENG JIT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BENG
Middle Name:JIT
Last Name:TAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2541
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-2209
Practice Address - Street 1:30 HARRISON ST
Practice Address - Street 2:SUITE 460
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2161
Practice Address - Country:US
Practice Address - Phone:607-763-8101
Practice Address - Fax:607-763-8049
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231029208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010231029OtherMONROE
NY2678971Medicaid
NY40403006189OtherFIDELIS
NY928140001OtherHEALTH NOW
NYP010231029OtherFAMILY HEALTH PLUS
NY27164801OtherUNIVERA
NY1000741OtherGHI
NYMDJ211OtherPREFERRED CARE
NY1913021OtherIHA
NY7238658OtherAETNA
NYP010231029OtherMONROE
NYP00257462Medicare ID - Type UnspecifiedMEDICARE RR
NY7238658OtherAETNA