Provider Demographics
NPI:1740440668
Name:DR. JIMMY TAO, MD
Entity type:Organization
Organization Name:DR. JIMMY TAO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:ZIMING
Authorized Official - Last Name:TAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-536-8084
Mailing Address - Street 1:200 CARMAN AVE
Mailing Address - Street 2:APT. A-6
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1147
Mailing Address - Country:US
Mailing Address - Phone:917-536-8084
Mailing Address - Fax:
Practice Address - Street 1:200 CARMAN AVE
Practice Address - Street 2:APT. A-6
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1147
Practice Address - Country:US
Practice Address - Phone:917-536-8084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital