| Kwei Ham Daniel Tan, Do Pllc | |
| 
					120 Sykes St Groton NY 13073-1231  | |
| (607) 591-5349 | |
| (607) 428-5077 | 
| Full Name | Kwei Ham Daniel Tan, Do Pllc | 
|---|---|
| Speciality | Family Medicine | 
| Location | 120 Sykes St, Groton, New York | 
| Authorized Official Name and Position | Winda Dickey (BILLING MANAGER) | 
| Authorized Official Contact | 7727770333 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Kwei Ham Daniel Tan, Do Pllc 417 S Jensen Rd Vestal NY 13850-3018 Ph: (772) 777-0333  | Kwei Ham Daniel Tan, Do Pllc 120 Sykes St Groton NY 13073-1231 Ph: (607) 591-5349  | 
| NPI Number | 1558194035 | 
|---|---|
| Provider Enumeration Date | 08/21/2024 | 
| Last Update Date | 08/21/2024 | 
| Medicare PECOS PAC ID | 4385179316 | 
|---|---|
| Medicare Enrollment ID | O20241127000861 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1558194035 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary | 
| Provider Name | Kwei Ham Daniel Tan | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1326533977 PECOS PAC ID: 5799032082 Enrollment ID: I20220606001302  | 
Peter Clark, Md, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 W South St, Groton, NY 13073 Phone: 607-898-3341 Fax: 607-898-3982  |