MEDICARE: DR. NORMAN JERMANE CHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MT199956	PA
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	282881	NY

General Provider Information

NPI Number	:	1003103615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN JERMANE CHAN M.D.

Provider Business Mailing Address
First Line	:	202 CANAL ST
Second Line	:	STE 602
City	:	NEW YORK
State	:	NY
Zip	:	10013-4517
Country	:	US
Telephone Number	:	917-261-2718
Fax Number	:	917-261-2719

Provider Business Practice Location Address
First Line	:	202 CANAL ST
Second Line	:	STE 602
City	:	NEW YORK
State	:	NY
Zip	:	10013-4517
Country	:	US
Telephone Number	:	917-261-2718
Fax Number	:	917-261-2719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2011
Last Update Date	:	01/15/2018

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