Provider Demographics
NPI:1699751057
Name:TZOU, NOLAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:DAVID
Last Name:TZOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6922
Mailing Address - Country:US
Mailing Address - Phone:631-629-4770
Mailing Address - Fax:631-629-4772
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6922
Practice Address - Country:US
Practice Address - Phone:631-629-4770
Practice Address - Fax:631-629-4772
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00458231OtherRAILROAD MEDICARE
NY5399651OtherGHI
NY97K051Medicare PIN
NYP00458231OtherRAILROAD MEDICARE