Provider Demographics
NPI:1861383820
Name:TANG, JEREMY (APRN, FNP)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MALT DR APT 459
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6972
Mailing Address - Country:US
Mailing Address - Phone:206-432-5292
Mailing Address - Fax:
Practice Address - Street 1:40 FLATBUSH AVENUE EXT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2903
Practice Address - Country:US
Practice Address - Phone:718-215-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY962375163W00000X
WARN61576608163W00000X
CT211405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty