Provider Demographics
NPI:1982912994
Name:TANCHAN, KRISTINE GASCON
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:GASCON
Last Name:TANCHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 38TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1901
Mailing Address - Country:US
Mailing Address - Phone:917-515-1680
Mailing Address - Fax:
Practice Address - Street 1:5009 38TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1901
Practice Address - Country:US
Practice Address - Phone:917-515-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0287601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist