1134149974 NPI number — SILIN G TAN OTR/L

Table of content: SILIN G TAN OTR/L (NPI 1134149974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134149974 NPI number — SILIN G TAN OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAN
Provider First Name:
SILIN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAN
Provider Other First Name:
GEORGE
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134149974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 QUANTUM LAKES DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33426-8324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-244-3627
Provider Business Mailing Address Fax Number:
561-244-9627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 QUANTUM LAKES DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33426-8324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-244-3627
Provider Business Practice Location Address Fax Number:
561-244-9627
Provider Enumeration Date:
07/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT04379 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT04379 . This is a "OT #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".