Provider Demographics
NPI:1710113949
Name:EDWIN K CHAN MD PC
Entity Type:Organization
Organization Name:EDWIN K CHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-8246
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8925
Mailing Address - Country:US
Mailing Address - Phone:718-321-8246
Mailing Address - Fax:
Practice Address - Street 1:13640 39TH AVE
Practice Address - Street 2:STE 6GB
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5536
Practice Address - Country:US
Practice Address - Phone:718-321-8246
Practice Address - Fax:718-321-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222486174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty