Healthcare Provider Details

I. General information

NPI: 1386937589
Provider Name (Legal Business Name): ALEXANDER CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E 60TH ST APT 29F
NEW YORK NY
10022-1524
US

IV. Provider business mailing address

161 W HARRISON ST UNIT 808
CHICAGO IL
60605-1086
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number277764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: