Provider Demographics
NPI:1497043020
Name:CHAN, PEARL (MS, SAS)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MS, SAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 GOLD ST
Mailing Address - Street 2:APT. 23B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3014
Mailing Address - Country:US
Mailing Address - Phone:614-937-4288
Mailing Address - Fax:
Practice Address - Street 1:306 GOLD ST
Practice Address - Street 2:APT. 23B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3014
Practice Address - Country:US
Practice Address - Phone:614-937-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency