Justin Chan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

042572-1 Issued in NY

Practice address

33 Richmond Hill Rd
Staten Island, NY 10314-5950

Phone

(718) 982-6340

NPI assigned

Dec 2, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Northeastern Ohio University College of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ergo Physical Therapy PCGroup PAC ID 9931123650, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ergo Physical Therapy, PC

  • Physical Therapist
  • Forest Hills, NY
  • NPI 1285856898
  Medicare reassignment Care Compare group NPD
• RB Physical and Occupational Therapy PLLC

  • Physical Therapist
  • Brooklyn, NY
  • NPI 1790013282
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512172800000",
    "number": "1215442082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 STAGE LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 RICHMOND HILL RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103145950",
            "telephone_number": "718-982-6340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JUSTIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-02",
        "last_updated": "2017-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "042572-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Kit Ying Chan, O.T.
• Doris Chan, D.O.
• Emily Rose Chan
• Gloria Chan, CRNA
• Juhyun Lisa Chan, P.A.
• Kamse Suk Chan, LCSW
• Katherine Chan, CCC-SLP
• Kristina Chan
• Kwun Y Chan, RN
• Peggy Chan, M.D.

• Physical Therapist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.