Provider Demographics
NPI:1285717256
Name:CHAN, TERRENCE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ANTHONY
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 139TH STREET
Mailing Address - Street 2:KEW GARDEN HILLS
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1113
Mailing Address - Country:US
Mailing Address - Phone:718-261-8328
Mailing Address - Fax:
Practice Address - Street 1:8111 139TH STREET
Practice Address - Street 2:KEW GARDEN HILLS
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1113
Practice Address - Country:US
Practice Address - Phone:718-261-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01415296Medicaid
NY37K43Medicare ID - Type Unspecified
NY01415296Medicaid