Provider Demographics
NPI:1124364005
Name:SHIH-HAN CHAN MEDICAL PC
Entity Type:Organization
Organization Name:SHIH-HAN CHAN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMEDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:1 HEWITT SQ
Mailing Address - Street 2:SUITE 146
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2519
Mailing Address - Country:US
Mailing Address - Phone:631-271-9151
Mailing Address - Fax:631-271-9155
Practice Address - Street 1:1 HEWITT SQ
Practice Address - Street 2:SUITE 146
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2519
Practice Address - Country:US
Practice Address - Phone:631-271-9151
Practice Address - Fax:631-271-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253140-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY253140-1OtherLICENSE