Provider Demographics
NPI:1700181112
Name:ELZIE CHAN-ENGLENDER OD PC
Entity Type:Organization
Organization Name:ELZIE CHAN-ENGLENDER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN-ENGLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-544-2200
Mailing Address - Street 1:630 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5569
Mailing Address - Country:US
Mailing Address - Phone:212-929-9682
Mailing Address - Fax:
Practice Address - Street 1:10720 71ST AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4725
Practice Address - Country:US
Practice Address - Phone:718-544-2200
Practice Address - Fax:718-544-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty