Provider Demographics
NPI:1568427243
Name:CHAN, ALEXANDER C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:C
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 1:13-17 ELIZABETH STREET
Mailing Address - Street 2:RM 409
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4903
Mailing Address - Country:US
Mailing Address - Phone:212-334-3999
Mailing Address - Fax:
Practice Address - Street 1:13-17 ELIZABETH STREET
Practice Address - Street 2:RM 409
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4903
Practice Address - Country:US
Practice Address - Phone:212-334-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02749439Medicaid
NYI52317Medicare UPIN
NY02749439Medicaid