Dr. Amil Kusain Tan Jr., PhD, RN, FNP
Nurse Practitioner, Family in Woodside, NY. Individual provider (NPI-1).
NPI number1467293126
StatusActive
Last updated in NPPESJun 5, 2024
Details
- NPI
- 1467293126
- Entity type
- Individual (NPI-1)
- Name
- Dr. Amil Kusain Tan Jr.
- Credential
- PhD, RN, FNP
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 5, 2024
- Certification date
- Jun 5, 2024
- Last updated
- Jun 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 354353 | NY | Yes |
Practice location
5718 Woodside Ave Ste 101Woodside, NY 11377-3400
Phone 917-633-7710
Mailing address
5718 Woodside Ave Ste 101Woodside, NY 11377-3400
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