Provider Demographics
NPI:1215250865
Name:ANG, DIANA TAN (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:TAN
Last Name:ANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 COLUMBUS CIR # D-13
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4383
Mailing Address - Country:US
Mailing Address - Phone:916-765-1616
Mailing Address - Fax:
Practice Address - Street 1:1223 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7402
Practice Address - Country:US
Practice Address - Phone:212-752-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054353-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174 133 329OtherNYS DRIVER'S LICENSE