Healthcare Provider Details

I. General information

NPI: 1376583856
Provider Name (Legal Business Name): TOMAS SALAZAR CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NEREID AVE
BRONX NY
10466
US

IV. Provider business mailing address

711 NEREID AVE.
BRONX NY
10466
US

V. Phone/Fax

Practice location:
  • Phone: 718-994-6755
  • Fax: 718-994-3032
Mailing address:
  • Phone: 718-994-6755
  • Fax: 718-994-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number170475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: