Provider Demographics
NPI:1609946599
Name:CHAN, EMILY LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LINDA
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:102 MAJOR RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JCT
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2334
Mailing Address - Country:US
Mailing Address - Phone:732-274-1602
Mailing Address - Fax:732-274-1602
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-274-1578
Practice Address - Fax:212-274-1584
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist