Provider Demographics
NPI:1346651247
Name:ANNA G.L. CHAN, M.D. P.C.
Entity Type:Organization
Organization Name:ANNA G.L. CHAN, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-828-9889
Mailing Address - Street 1:1273 CARLLS STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8015
Mailing Address - Country:US
Mailing Address - Phone:631-828-9889
Mailing Address - Fax:631-242-2778
Practice Address - Street 1:14105 CHERRY AVE
Practice Address - Street 2:STE 1E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3291
Practice Address - Country:US
Practice Address - Phone:631-828-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty