Healthcare Provider Details

I. General information

NPI: 1275875809
Provider Name (Legal Business Name): FERDINAND J CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 05/16/2021
Certification Date: 05/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PL 11TH FLOOR
BRONX NY
10461-2720
US

IV. Provider business mailing address

1250 WATERS PL 11TH FLOOR
BRONX NY
10461-2720
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-4410
  • Fax: 347-577-4451
Mailing address:
  • Phone: 347-577-4410
  • Fax: 347-577-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number293373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: