Healthcare Provider Details

I. General information

NPI: 1871519819
Provider Name (Legal Business Name): GILBERT LAVARIAS CHAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 DREISER LOOP
BRONX NY
10475-2704
US

IV. Provider business mailing address

120 NEWHAM AVE
BRENTWOOD NY
11717-5624
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2955
  • Fax: 888-583-1385
Mailing address:
  • Phone: 631-813-2143
  • Fax: 888-552-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number028152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: