Provider Demographics
NPI:1427129071
Name:TAN, KAREN LIZHONG (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LIZHONG
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 STATE HIGHWAY 30
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7532
Mailing Address - Country:US
Mailing Address - Phone:518-842-8185
Mailing Address - Fax:518-842-8189
Practice Address - Street 1:5010 STATE HIGHWAY 30
Practice Address - Street 2:SUITE 204
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-842-8185
Practice Address - Fax:518-842-8189
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183416207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01515397Medicaid
NYAA1665Medicare ID - Type Unspecified
NY01515397Medicaid