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General NPI Number Information
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NPI Number | 1245773829
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Entity Type | Organization
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Legal Business Name | TODT HILL DIGESTIVE MEDICAL DISEASE, PC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 78 TODT HILL ROAD SUITE 301
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4536
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Country | US
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Telephone | 718-986-5394
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Fax | 718-785-9864
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Provider Business Mailing Address
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Address Line | 78 TODT HILL RD SUITE 301
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4513
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Country | US
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Telephone | 718-986-5394
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Fax | 718-785-9864
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALLEN CHAN
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Credential | MD
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Telephone | 718-448-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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