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General NPI Number Information
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NPI Number | 1255862025
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Entity Type | Organization
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Legal Business Name | INSPIRA DERMATOLOGY PLLC
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 13636 39TH AVE 5TH FLOOR
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City | FLUSHING
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State | NY
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Zip | 11354-5599
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Country | US
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Telephone | 718-509-6475
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Fax | 718-509-6467
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Provider Business Mailing Address
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Address Line | 13636 39TH AVE 5TH FLOOR
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City | FLUSHING
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State | NY
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Zip | 11354-5599
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Country | US
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Telephone | 718-509-6475
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Fax | 718-509-6467
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Authorized Official
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Title or Position | PHYSICIAN
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Name | WAI PING CHAN
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Credential | D.O.
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Telephone | 718-509-6475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 250588
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License Number State | NY
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