=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184872582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANE CHAN, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2008
-----------------------------------------------------
Last Update Date | 11/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 VETERANS RD SUITE 201
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-962-1300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 VETERANS RD SUITE 201
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-962-1300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. DONNA HENN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-962-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 175507
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------