Provider Demographics
NPI:1700831518
Name:CHAN, COLLIER (DPM)
Entity Type:Individual
Prefix:DR
First Name:COLLIER
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 JUSTICE AVE
Mailing Address - Street 2:SUITE CX
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4575
Mailing Address - Country:US
Mailing Address - Phone:718-446-4230
Mailing Address - Fax:718-457-7015
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:SUITE CX
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4575
Practice Address - Country:US
Practice Address - Phone:718-446-4230
Practice Address - Fax:718-457-7015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003901213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT84821Medicare UPIN