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General NPI Number Information
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NPI Number | 1043287857
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Entity Type | Individual
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Provider Name | WALLEN CY CHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 78 TODT HILL RD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4528
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Country | US
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Telephone | 718-448-1122
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Fax | 718-448-8318
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Provider Business Mailing Address
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Address Line | 4 AIRDALE DR
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City | KENDALL PARK
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State | NJ
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Zip | 08824-1494
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Country | US
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Telephone | 718-448-1122
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Fax | 718-448-8318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 183203
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License Number State | NY
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