Provider Demographics
NPI:1184970113
Name:LEONG HEAN TAN MD PA
Entity type:Organization
Organization Name:LEONG HEAN TAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONG
Authorized Official - Middle Name:HEAN
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-852-0901
Mailing Address - Street 1:PO BOX 7205
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-7205
Mailing Address - Country:US
Mailing Address - Phone:908-852-0901
Mailing Address - Fax:908-850-8730
Practice Address - Street 1:121 SHELLEY DR STE 1D
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2530
Practice Address - Country:US
Practice Address - Phone:908-852-0901
Practice Address - Fax:908-850-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2820307Medicaid
NJTA104403OtherMEDICARE ID/PTAN
NJ2820307Medicaid