Provider Demographics
NPI:1396738332
Name:CHAN, GERMAINE Z (MD)
Entity type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:Z
Last Name:CHAN
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:PO BOX 95000-4145
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:212-315-0144
Mailing Address - Fax:212-315-0196
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-961-5530
Practice Address - Fax:212-531-7650
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187631-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134072Medicaid
NY23N581Medicare ID - Type Unspecified
NY02134072Medicaid