Healthcare Provider Details

I. General information

NPI: 1558369397
Provider Name (Legal Business Name): ALFONSO YU CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

IV. Provider business mailing address

105 WHEATLEY RD
OLD WESTBURY NY
11568-1210
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax:
Mailing address:
  • Phone: 516-625-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number108148
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: