Healthcare Provider Details

I. General information

NPI: 1700108537
Provider Name (Legal Business Name): DR. SHERRY KWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2010
Last Update Date: 02/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 LEXINGTON AVE
NEW YORK NY
10022-4614
US

IV. Provider business mailing address

3110 46TH ST 2ND FLOOR
LONG ISLAND CITY NY
11103-1606
US

V. Phone/Fax

Practice location:
  • Phone: 917-369-8688
  • Fax: 917-369-8705
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: