Individual
VIVIAN C TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
462 GRIDER ST, BUFFALO, NY 14215-3021
(716) 898-3416
Mailing address
462 GRIDER ST, BUFFALO, NY 14215-3021
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2114801
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025568101
UNIVERA
—
01
—
000525320003
BLUE SHIELD OF WESTERN NY
—
05
—
01876553
—
NY
01
—
140848FF
PREFERRED CARE
—
01
—
2114809W
WORKERS COMPENSATION
NY
01
—
300122828
RAILROAD MEDICARE
—
01
—
5610372
INDEPENDANT HEALTH
—
Enumeration date
06/09/2006
Last updated
05/20/2008
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