Provider Demographics
NPI:1386772531
Name:FAN-PAUL, NANCY I (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:I
Last Name:FAN-PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 39TH AVE
Mailing Address - Street 2:STE 403
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5565
Mailing Address - Country:US
Mailing Address - Phone:914-723-1641
Mailing Address - Fax:914-723-5468
Practice Address - Street 1:13640 39TH AVE STE 403
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5565
Practice Address - Country:US
Practice Address - Phone:718-353-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204187-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY41Z063Medicare ID - Type UnspecifiedSCARSDALE
NYG95707Medicare UPIN
NY41Z062Medicare ID - Type UnspecifiedCOLUMBIA