Samuel Chan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

045102 Issued in NY

Practice address

143 Darnell LN
Staten Island, NY 10309-1954

Phone

(718) 227-6244

NPI assigned

Apr 17, 2020

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

Other, 2019

Medicare assignment

May accept Medicare assignment

Group practices

Bespoke Treatments Physical Therapy PCGroup PAC ID 0042746240, 23 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.

• Bespoke Treatments Physical Therapy PC

  • Physical Therapy Clinic/Center
  • New York, NY
  • NPI 1336756758
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1518587773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 DARNELL LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103091954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 DARNELL LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103091954",
            "telephone_number": "718-227-6244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "045102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kamse Suk Chan, LCSW
• Katherine Chan, CCC-SLP
• Kristina Chan
• Kwun Y Chan, RN
• Peggy Chan, M.D.
• Siu-Pun Chan, MD
• Wallen Cy Chan, M.D.
• Yeoman Kin-Lung Chan, MD
• Yun Wa Chan
• Helen Chandler

• 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 Jul 17, 2023; 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.