Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 201667 | NY |
NPI | 1548399173 |
---|---|
Provider Name | Susan Lee Chan |
First Address | New Hyde Park, NY 11042-1113 |
Second Address | Wantagh, NY 11793-2136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 29/07/2015 |