Provider Demographics
NPI:1780074633
Name:TAN, JAY YUHUAT (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:YUHUAT
Last Name:TAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 W 21ST ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6908
Mailing Address - Country:US
Mailing Address - Phone:646-775-9355
Mailing Address - Fax:
Practice Address - Street 1:54 W 21ST ST
Practice Address - Street 2:SUITE 510
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6908
Practice Address - Country:US
Practice Address - Phone:646-755-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor