Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 005920-1 | NY |
NPI | 1003065327 |
---|---|
Provider Name | Mr. Wai Hung Steve Chan |
First Address | Long Island City, NY 11101 |
Second Address | Long Island City, NY 11101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 01/10/2012 |