Individual
JUHYUN LISA CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9158
(718) 226-6964
Mailing address
4 AIRDALE DR, KENDALL PARK, NJ 08824-1494
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006335
NY
363AM0700X
Medical Physician Assistant
25MP00050600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01991840
—
NY
Enumeration date
04/30/2012
Last updated
01/25/2013
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