Healthcare Provider Details

I. General information

NPI: 1215952478
Provider Name (Legal Business Name): YUK-WAH CHAN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 MAIN ST SUITE C, FIRST FLOOR
PLEASANT VALLEY NY
12569-7834
US

IV. Provider business mailing address

PO BOX 561
PLEASANT VALLEY NY
12569-0561
US

V. Phone/Fax

Practice location:
  • Phone: 845-635-9417
  • Fax: 845-635-9419
Mailing address:
  • Phone: 845-635-9417
  • Fax: 845-635-9419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number169558
License Number StateNY

VIII. Authorized Official

Name: YUK-WAH CHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 845-635-9417