Individual
MR. MARK TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
222 MIDDLE COUNTRY ROAD, SUITE 312, SMITHTOWN, NY 11787
(631) 724-8900
(631) 724-8901
Mailing address
222 MIDDLE COUNTRY ROAD, SUITE 312, SMITHTOWN, NY 11787
(631) 724-8900
(631) 724-8901
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
165674
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00986705
—
NY
Enumeration date
12/29/2006
Last updated
07/27/2011
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