Provider Demographics
NPI:1255652020
Name:FAN, CATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 6TH ST NYP-BMH DEPARTMENT OF PATHOLOGY
Mailing Address - Street 2:
Mailing Address - City:PARK SLOPE
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:718-780-3672
Mailing Address - Fax:718-780-3673
Practice Address - Street 1:506 6TH STREET
Practice Address - Street 2:
Practice Address - City:PARK SLOPE
Practice Address - State:NY
Practice Address - Zip Code:11215-1433
Practice Address - Country:US
Practice Address - Phone:718-380-3672
Practice Address - Fax:718-780-3672
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241734207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1255652020Medicaid