Healthcare Provider Details

I. General information

NPI: 1093513467
Provider Name (Legal Business Name): JIMMY CHAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST FL HALL7
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

656 CENTRAL PARK AVE # 168
SCARSDALE NY
10583-2512
US

V. Phone/Fax

Practice location:
  • Phone: 914-471-0667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JIMMY CHAN
Title or Position: MEMBER
Credential: MD
Phone: 914-471-0667