Individual
DR. EDGARDO TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
314 1ST AVE, ELIZABETH, NJ 07206-1659
(908) 353-5280
Mailing address
314 1ST AVE, ELIZABETH, NJ 07206-1659
(908) 353-5280
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
25MA 042112
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01000060500
AMERICHOICE
NJ
01
—
1027297
HORIZON NJ HEALTH
NJ
01
—
12278
AMERIGROUP
NJ
05
—
1398709
—
NJ
Enumeration date
12/13/2006
Last updated
07/09/2007
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