Healthcare Provider Details

I. General information

NPI: 1073010021
Provider Name (Legal Business Name): MELISSA K CHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 PRESIDENT ST STE B
BROOKLYN NY
11215-1212
US

IV. Provider business mailing address

333 SCHERMERHORN ST APT 45J
BROOKLYN NY
11217-3896
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-5437
  • Fax:
Mailing address:
  • Phone: 908-420-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number312576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: