Healthcare Provider Details

I. General information

NPI: 1447449277
Provider Name (Legal Business Name): MICHELE AI-LING CHAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

94 TEHAMA ST
BROOKLYN NY
11218-2112
US

V. Phone/Fax

Practice location:
  • Phone: 347-442-6197
  • Fax: 718-780-5687
Mailing address:
  • Phone: 917-226-8844
  • Fax: 516-437-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010059-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: