Healthcare Provider Details

I. General information

NPI: 1366805798
Provider Name (Legal Business Name): ANGELA CHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAMARONECK AVE
HARRISON NY
10528-1635
US

IV. Provider business mailing address

600 MAMARONECK AVE
HARRISON NY
10528-1635
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number298394
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number298394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: