Individual
DR. ELIZABETH LISTIANI TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
204 ARK RD, MOUNT LAUREL, NJ 08054-3100
(856) 866-8102
Mailing address
1295 ROUTE 38, PO BOX 479, HAINESPORT, NJ 08036-2702
(609) 914-7017
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA08161200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017419190001
—
PA
05
—
0129267
—
NJ
Enumeration date
01/25/2006
Last updated
03/19/2013
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