Provider Demographics
NPI:1093903304
Name:CHAN, BERNARD P (LAC)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:P
Last Name:CHAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:BERNARD
Other - Middle Name:P
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-0879
Mailing Address - Country:US
Mailing Address - Phone:646-386-6222
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:646-386-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003333171100000X
NJ25MZ00086900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist