Provider Demographics
NPI:1376583856
Name:CHAN, TOMAS SALAZAR (MD)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:SALAZAR
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NEREID AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:718-994-6755
Mailing Address - Fax:718-994-3032
Practice Address - Street 1:711 NEREID AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:718-994-6755
Practice Address - Fax:718-994-3032
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01022348Medicaid
NYA59914Medicare UPIN
NY01022348Medicaid