Individual
JEFFREY CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8906 135TH ST, SUITE 2T, JAMAICA, NY 11418-2821
(718) 206-7110
(718) 206-7111
Mailing address
80 MARCUS DR, PROVIDER ENROLLMENT, MELVILLE, NY 11747-4230
(631) 391-7889
(631) 454-4163
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
206686
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01755004
—
NY
Enumeration date
03/30/2006
Last updated
02/14/2014
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