| Doctor Name: | WILSON L TAN |
| NPI Number: | 1215003934 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 25MA04257700 |
| Business Practice Address: | 1676 E Landis Ave Vineland, NJ - 08362 |
| Business Phone Number: | 8566966431 |
| Business Fax Number: | 8567945803 |
| Mailing Address: | 2430 Monroe Ave, VINELAND |
| State: | NJ |
| Postal Code: | 08361 |
| Phone Number: | 8566910080 |
| Fax Number: | |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 12/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MA04257700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |