MEDICARE: DR. EMIA CHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	205626	NY

General Provider Information

NPI Number	:	1902980139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMIA CHAN M.D.

Provider Business Mailing Address
First Line	:	535 PORT WASHINGTON BLVD
Second Line	:	SUITE 201
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-4217
Country	:	US
Telephone Number	:	516-944-9515
Fax Number	:	516-767-5156

Provider Business Practice Location Address
First Line	:	535 PORT WASHINGTON BLVD
Second Line	:	SUITE 201
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-4217
Country	:	US
Telephone Number	:	516-944-9515
Fax Number	:	516-767-5156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/01/2008

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