Provider Demographics
NPI:1801039789
Name:TAN, MINYI (MD)
Entity type:Individual
Prefix:
First Name:MINYI
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 EDMUND D PELLEGRINO RD
Practice Address - Street 2:STONY BROOK ANAESTHESIOLOGY - PAIN MANAGEMENT CENTER
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-9464
Practice Address - Country:US
Practice Address - Phone:631-638-0800
Practice Address - Fax:631-638-0765
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY269249207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine