Provider Demographics
NPI:1982831228
Name:TAN, JOSENIA NARCISA MAILED (MD)
Entity Type:Individual
Prefix:
First Name:JOSENIA NARCISA
Middle Name:MAILED
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:MAILED
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-723-7765
Mailing Address - Fax:585-273-3637
Practice Address - Street 1:1561 LONG POND RD STE 130
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4136
Practice Address - Country:US
Practice Address - Phone:585-723-7765
Practice Address - Fax:585-273-3637
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241466207ZP0102X
NY274796207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology