Provider Demographics
NPI:1982633822
Name:MELISSA M CHAN, PLLC
Entity Type:Organization
Organization Name:MELISSA M CHAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MAN-LAI
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-343-2536
Mailing Address - Street 1:139 CENTRE STREET
Mailing Address - Street 2:SUITE PH 104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4559
Mailing Address - Country:US
Mailing Address - Phone:212-343-2536
Mailing Address - Fax:212-343-2537
Practice Address - Street 1:139 CENTRE STREET
Practice Address - Street 2:SUITE PH 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4559
Practice Address - Country:US
Practice Address - Phone:212-343-2536
Practice Address - Fax:212-343-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01659732Medicaid
NYWET771Medicare PIN
NYG28678Medicare UPIN