Individual
KONG TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
727 N BEERS ST, HOLMDEL, NJ 07733-1514
(732) 739-5847
Mailing address
PO BOX 60280, CHARLESTON, SC 29419-0280
(732) 739-5847
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA03121400
NJ
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25MA03121400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0152871
—
NJ
01
—
221494442
TAX ID#
NJ
01
—
2406192000
AMERIHEALTH #
NJ
01
—
60014873
HORIZON NJ HEALTH #
NJ
01
—
P00247907
RR MDCR #
NJ
01
—
P3617811
OXFORD #
NJ
01
—
XK5557
HEALTHNET #
NJ
Enumeration date
06/14/2006
Last updated
01/04/2011
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