Individual
ALFONSO TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
297 W MAIN ST, SAYVILLE, NY 11782-2523
(631) 589-2323
(631) 589-9069
Mailing address
297 W MAIN ST, SAYVILLE, NY 11782-2523
(631) 589-2323
(631) 589-9069
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
115465
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00213052
—
NY
Enumeration date
07/12/2006
Last updated
07/08/2007
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