Individual
DR. JACQUELINE CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
139 CENTRE ST, SUITE 307, NEW YORK, NY 10013-4552
(212) 334-3507
(212) 334-4728
Mailing address
139 CENTRE ST, SUITE 307, NEW YORK, NY 10013-4552
(212) 334-3507
(212) 334-4728
Taxonomy
Speciality
Code
Description
License number
State
207RA0002X
Adult Congenital Heart Disease Physician
246413
NY
207RC0000X
Cardiovascular Disease Physician
Primary
246413
NY
207UN0902X
Nuclear Imaging & Therapy Physician
246413
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03350121
—
NY
Enumeration date
06/02/2009
Last updated
11/20/2018
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