Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 233455 | NY |
NPI | 1609859875 |
---|---|
Provider Name | Dr. Peggy Chan |
First Address | Staten Island, NY 10310-1666 |
Second Address | Staten Island, NY 10310-1666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02685490 | (05) | NY |
I27593 | (02) | NY |