Individual
ELIZABETH TENGCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
290 E MAIN ST, SMITHTOWN, NY 11787-2916
(631) 361-4802
Mailing address
290 E MAIN ST, SMITHTOWN, NY 11787-2916
(631) 361-4802
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
016400
NY
Other
Enumeration date
02/12/2013
Last updated
03/22/2018
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