1073842233 NPI number — PARD H. CHAN OD,PC

Table of content: TINA BEVERLY MOJOKO BESONG (NPI 1265263644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073842233 NPI number — PARD H. CHAN OD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARD H. CHAN OD,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073842233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 NOTTINGHAM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-3846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-352-9797
Provider Business Mailing Address Fax Number:
845-352-3991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 OVERLOOK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954-5290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-426-2044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
PARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-352-9797

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV004766 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)