Healthcare Provider Details

I. General information

NPI: 1255151619
Provider Name (Legal Business Name): AMY TUNGCHING CHAN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHARLES B. WANG COMMUNITY HEALTH CENTER 125 WALKER STREET, 2 ND FLOOR,
NEW YORK NY
10013
US

IV. Provider business mailing address

CHARLES B. WANG COMMUNITY HEALTH CENTER 125 WALKER STREET, 2 ND FLOOR,
NEW YORK NY
10013
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-3888
  • Fax: 212-226-2289
Mailing address:
  • Phone: 212-226-3888
  • Fax: 212-226-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number961097
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: