MEDICARE: DR. SAMUEL S 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	207RC0000X	Cardiovascular Disease Physician	193850-1	NY
2	246XC2901X	Cardiovascular Invasive Specialist/Technologist	193850-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1376729426	OTHER	NY	NPI-GROUP ORGANIZATION
5	1841253267	OTHER	NY	NPI-INDIVIDUAL PROVIDER
6	1376729426	OTHER	NY	GROUP NPI (DOCTOR CHAN MEDICAL PRACTICE, PC)
7	1841253267	OTHER	NY	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1841253267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL S CHAN M.D.

Provider Business Mailing Address
First Line	:	202 CANAL ST
Second Line	:	SUITE 801
City	:	NEW YORK
State	:	NY
Zip	:	10013-4517
Country	:	US
Telephone Number	:	212-406-2301
Fax Number	:	212-406-2359

Provider Business Practice Location Address
First Line	:	202 CANAL ST
Second Line	:	SUITE 801
City	:	NEW YORK
State	:	NY
Zip	:	10013-4517
Country	:	US
Telephone Number	:	212-406-2301
Fax Number	:	212-406-2359

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	06/23/2017

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Directions to “ DR. SAMUEL S CHAN M.D.” Practice Location

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