Provider Demographics
NPI:1053935064
Name:TAN, JANICE Y
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:Y
Last Name:TAN
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 1:3808 UNION ST # 3M-L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5543
Mailing Address - Country:US
Mailing Address - Phone:929-666-5048
Mailing Address - Fax:929-666-5049
Practice Address - Street 1:3808 UNION ST # 3M-L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5543
Practice Address - Country:US
Practice Address - Phone:929-666-5048
Practice Address - Fax:929-666-5049
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009213152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist