Provider Demographics
NPI:1336186592
Name:TANG, JICHENG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JICHENG
Middle Name:
Last Name:TANG
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 1:79 E POST RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5008
Mailing Address - Country:US
Mailing Address - Phone:914-948-1192
Mailing Address - Fax:914-948-1365
Practice Address - Street 1:79 E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5008
Practice Address - Country:US
Practice Address - Phone:914-948-1192
Practice Address - Fax:914-948-1365
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2184012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH54108FMedicare UPIN
NY037BA1Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER