Healthcare Provider Details

I. General information

NPI: 1518428622
Provider Name (Legal Business Name): NICHOLAS CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

520 E 70TH ST
NEW YORK NY
10021-9800
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-5558
  • Fax: 212-746-6665
Mailing address:
  • Phone: 646-962-5558
  • Fax: 212-746-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number315494
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: