EDWIN V TAN
Physician/surgeon


Address: 720 West 170th St, New York, NY 10032

EDWIN V TAN (Credential# 552375) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is February 26, 1996. The license expiration date date is February 28, 1997. The license status is INACTIVE.

Business Overview

EDWIN V TAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.034779. The credential type is physician/surgeon. The effective date is February 26, 1996. The expiration date is February 28, 1997. The business address is 720 West 170th St, New York, NY 10032. The current status is inactive.

Basic Information

Licensee Name EDWIN V TAN
Credential ID 552375
Credential Number 1.034779
Credential Type Physician/Surgeon
Business Address 720 West 170th St
New York
NY 10032
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1995-08-04
Effective Date 1996-02-26
Expiration Date 1997-02-28
Refresh Date 2009-07-08

Office Location

Street Address 720 WEST 170TH ST
City NEW YORK
State NY
Zip Code 10032

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Andrea M Powell 552 West 165th St., New York, NY 10032 Physician Assistant 2020-07-01 ~ 2021-06-30
Mitchell S Elkind 710 W. 168th Street, New York, NY 10032 Physician/surgeon 2020-05-01 ~ 2021-04-30
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Rainer N Mittl 635 West 165th Street, New York, NY 10032 Physician/surgeon 2020-04-01 ~ 2021-03-31
Tristan Timothy Sands 180 Fort Washington Ave, 5th Floor, New York, NY 10032 Physician/surgeon ~
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Competitor

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City NEW YORK
Zip Code 10032
License Type Physician/Surgeon
License Type + County Physician/Surgeon + NEW YORK

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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