Provider Demographics
NPI:1245773829
Name:TODT HILL DIGESTIVE MEDICAL DISEASE, PC
Entity Type:Organization
Organization Name:TODT HILL DIGESTIVE MEDICAL DISEASE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-448-1122
Mailing Address - Street 1:78 TODT HILL RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4513
Mailing Address - Country:US
Mailing Address - Phone:718-986-5394
Mailing Address - Fax:718-785-9864
Practice Address - Street 1:78 TODT HILL ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4536
Practice Address - Country:US
Practice Address - Phone:718-986-5394
Practice Address - Fax:718-785-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory