MEDICARE: ERIC CHAN

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	225100000X	Physical Therapist	040396	NY

General Provider Information

NPI Number	:	1144776592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CHAN

Provider Business Mailing Address
First Line	:	2142 UTOPIA PKWY
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-4142
Country	:	US
Telephone Number	:	718-819-6805
Fax Number	:	347-841-9109

Provider Business Practice Location Address
First Line	:	552 BROADWAY
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10012-3922
Country	:	US
Telephone Number	:	212-226-6704
Fax Number	:	212-226-8207

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

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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Directions to “ ERIC CHAN ” Practice Location

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