Provider Demographics
NPI:1124448121
Name:ANNE CHAN-LY, DDS, PLLC
Entity type:Organization
Organization Name:ANNE CHAN-LY, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN-LY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-751-4590
Mailing Address - Street 1:136 BOWERY STE 203
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4290
Mailing Address - Country:US
Mailing Address - Phone:917-751-4590
Mailing Address - Fax:
Practice Address - Street 1:208-54 CROSS ISLAND PARKWAY
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360
Practice Address - Country:US
Practice Address - Phone:718-631-0508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053963-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental