Provider Demographics
NPI:1336663905
Name:EMILIA JUNE CHAN INCORPORATION
Entity Type:Organization
Organization Name:EMILIA JUNE CHAN INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILIA JUNE
Authorized Official - Middle Name:IMUTAN
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:SAS, MED
Authorized Official - Phone:917-640-0773
Mailing Address - Street 1:1624 RADCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4015
Mailing Address - Country:US
Mailing Address - Phone:917-640-0773
Mailing Address - Fax:347-621-5806
Practice Address - Street 1:1624 RADCLIFF AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4015
Practice Address - Country:US
Practice Address - Phone:917-640-0773
Practice Address - Fax:347-621-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency