MEDICARE: CALEB FAN

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	207YX0901X	Otology & Neurotology Physician	327077-01	NY

General Provider Information

NPI Number	:	1538558465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB FAN

Provider Business Mailing Address
First Line	:	186 E 76TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2822
Country	:	US
Telephone Number	:	410-955-3080
Fax Number	:	212-434-2323

Provider Business Practice Location Address
First Line	:	186 E 76TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2822
Country	:	US
Telephone Number	:	212-434-2323
Fax Number	:

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

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	07/14/2025

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Directions to “ CALEB FAN ” Practice Location

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