Provider Demographics
NPI:1336696251
Name:TILSON, CHANA (DR)
Entity type:Individual
Prefix:
First Name:CHANA
Middle Name:
Last Name:TILSON
Suffix:
Gender:
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BROAD STREET
Mailing Address - Street 2:SUITE 1408
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004
Mailing Address - Country:US
Mailing Address - Phone:212-512-0860
Mailing Address - Fax:212-512-0861
Practice Address - Street 1:30 BROAD STREET
Practice Address - Street 2:SUITE 1408
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004
Practice Address - Country:US
Practice Address - Phone:212-512-0860
Practice Address - Fax:212-512-0861
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY71000813103K00000X
NY000813103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst