Healthcare Provider Details

I. General information

NPI: 1760839237
Provider Name (Legal Business Name): ALISON CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2016
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 85TH ST
NEW YORK NY
10028
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 3000
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6585
  • Fax:
Mailing address:
  • Phone: 212-987-3100
  • Fax: 212-731-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number297172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: