Provider Demographics
NPI:1033128749
Name:CHAN, JOHN Y (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Y
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:220 E COLUMBIA AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1902
Mailing Address - Country:US
Mailing Address - Phone:201-313-3365
Mailing Address - Fax:201-313-4467
Practice Address - Street 1:198 CANAL STREET
Practice Address - Street 2:SUITE 504-505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4531
Practice Address - Country:US
Practice Address - Phone:212-233-2223
Practice Address - Fax:201-313-4467
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005566103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00776641Medicaid
NY00776641Medicaid