Basic Information
| Provider Information | |||||||||
| NPI: | 1952559064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MEI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH, FAAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 WALKER ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100134135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122268866 | ||||||||
| FaxNumber: | 2122262289 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 WALKER ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100134135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122263888 | ||||||||
| FaxNumber: | 2123346887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 178032 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0006X | 178032 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01726118 | 05 | NY | MEDICAID |