Provider Demographics
NPI:1205169885
Name:JIANG, TONY TAN (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:TAN
Last Name:JIANG
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 1:252 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1248
Mailing Address - Country:US
Mailing Address - Phone:973-822-3338
Mailing Address - Fax:973-822-8098
Practice Address - Street 1:252 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1248
Practice Address - Country:US
Practice Address - Phone:973-822-3338
Practice Address - Fax:973-822-8098
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJP-0016171100000X
NJ25MA06699400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP-0016OtherACUPUNCTURE EXAMINING BOARD