Provider Demographics
NPI:1932236064
Name:TAN, ENGKOCK (MD)
Entity type:Individual
Prefix:DR
First Name:ENGKOCK
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 32ND ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2532
Mailing Address - Country:US
Mailing Address - Phone:212-665-5992
Mailing Address - Fax:212-665-1855
Practice Address - Street 1:3137 32ND ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2532
Practice Address - Country:US
Practice Address - Phone:212-665-5992
Practice Address - Fax:212-665-1855
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001194132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00223863Medicaid
NY00223863Medicaid