Healthcare Provider Details

I. General information

NPI: 1750219242
Provider Name (Legal Business Name): WAYNE CHAN NP IN ADULT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVENUE EXT
ALBANY NY
12203-5335
US

IV. Provider business mailing address

99 WALL ST STE 2071
NEW YORK NY
10005-4301
US

V. Phone/Fax

Practice location:
  • Phone: 518-428-8610
  • Fax: 518-854-0654
Mailing address:
  • Phone: 518-428-8610
  • Fax: 518-854-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WAYNE ELROY CHAN
Title or Position: NP/ OWNER
Credential:
Phone: 518-428-8610