Basic Information
| Provider Information | |||||||||
| NPI: | 1770758476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | ADRIAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 MAIN STREET | ||||||||
| Address2: | MEDICINE DEPT - NEUROLOGY | ||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737542000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 228 SAINT CHARLES WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174024661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178515503 | ||||||||
| FaxNumber: | 7178515507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 002854 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | MD442832 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 25MB08971300 | NJ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 102610692 | 05 | PA | MEDICAID | 417519 | 01 | PA | UPMC | OTHER | 2636016 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30103337 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 02916952 | 05 | NY | MEDICAID | 974285 | 01 | MD | CAREFIRST MD | OTHER |