Provider Demographics
NPI:1417912031
Name:CHAN, MELISSA MAN-LAI (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAN-LAI
Last Name:CHAN
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 1:139 CENTRE STREET
Mailing Address - Street 2:SUITE PH 104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4559
Mailing Address - Country:US
Mailing Address - Phone:212-343-2536
Mailing Address - Fax:212-343-2537
Practice Address - Street 1:139 CENTRE STREET
Practice Address - Street 2:SUITE PH 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4559
Practice Address - Country:US
Practice Address - Phone:212-343-2536
Practice Address - Fax:212-343-2537
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01659732Medicaid
NY141AD1Medicare PIN
NY01659732Medicaid