Healthcare Provider Details

I. General information

NPI: 1720151145
Provider Name (Legal Business Name): ALICE MAN CHAN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE MAN YING CHAN

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST SUITE 803
NEW YORK NY
10013-4408
US

IV. Provider business mailing address

202 SHORE RD
DOUGLASTON NY
11363-1118
US

V. Phone/Fax

Practice location:
  • Phone: 212-406-1968
  • Fax: 212-431-1044
Mailing address:
  • Phone: 718-428-2380
  • Fax: 718-353-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: