Individual
TERRY PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NUTRITIONIST
Contact information
Practice address
113 HOLLAND AVENUE, VA HOSPITAL, ALBANY, NY 12208
(518) 626-6868
(518) 626-5678
Mailing address
113 HOLLAND AVE, ALBANY, NY 12208-3410
(518) 626-6868
(518) 626-5678
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
005564
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005561
LICENSE
NY
Enumeration date
10/13/2006
Last updated
12/17/2012
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