Provider Demographics
NPI:1245427111
Name:TAN, EGBERT AUNG KYAING
Entity type:Individual
Prefix:
First Name:EGBERT
Middle Name:AUNG KYAING
Last Name:TAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EGBERT
Other - Middle Name:A
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:899 POST RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5517
Mailing Address - Country:US
Mailing Address - Phone:914-725-5442
Mailing Address - Fax:
Practice Address - Street 1:2640 W POINT RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1344
Practice Address - Country:US
Practice Address - Phone:920-490-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1831402084P0800X
WI28445-202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry