Individual
JERRY TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, RD, CDN
Contact information
Practice address
299 BROOME ST APT 9, NEW YORK, NY 10002-3729
(917) 781-5767
Mailing address
299 BROOME ST APT 9, NEW YORK, NY 10002-3729
(917) 781-5767
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86063459
NY
Other
Enumeration date
12/24/2020
Last updated
12/28/2020
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