Provider Demographics
NPI:1194871962
Name:CHAN, JEANNY (CA)
Entity type:Individual
Prefix:MS
First Name:JEANNY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:308 SPRINGFIELD AVE
Mailing Address - Street 2:#2
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1278
Mailing Address - Country:US
Mailing Address - Phone:908-723-1580
Mailing Address - Fax:908-688-5897
Practice Address - Street 1:308 SPRINGFIELD AVE
Practice Address - Street 2:#2
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1278
Practice Address - Country:US
Practice Address - Phone:908-723-1580
Practice Address - Fax:908-688-5897
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00026700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist