Provider Demographics
NPI:1942417902
Name:TIAN, FANG (MD)
Entity type:Individual
Prefix:
First Name:FANG
Middle Name:
Last Name:TIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 KNEELAND AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2713
Mailing Address - Country:US
Mailing Address - Phone:347-438-1534
Mailing Address - Fax:
Practice Address - Street 1:4161 KISSENA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3105
Practice Address - Country:US
Practice Address - Phone:347-438-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254139208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation