Provider Demographics
NPI:1902980139
Name:CHAN, EMIA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMIA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PORT WASHINGTON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4217
Mailing Address - Country:US
Mailing Address - Phone:516-944-9515
Mailing Address - Fax:516-767-5156
Practice Address - Street 1:535 PORT WASHINGTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4217
Practice Address - Country:US
Practice Address - Phone:516-944-9515
Practice Address - Fax:516-767-5156
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24N401Medicare PIN
NYG49908Medicare UPIN