Provider Demographics
NPI:1447449277
Name:CHAN, MICHELE AI-LING (PA)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:AI-LING
Last Name:CHAN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:94 TEHAMA ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2112
Mailing Address - Country:US
Mailing Address - Phone:917-226-8844
Mailing Address - Fax:516-437-4167
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:347-442-6197
Practice Address - Fax:718-780-5687
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2023-05-15
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Provider Licenses
StateLicense IDTaxonomies
NY010059-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400001103Medicare PIN