Provider Demographics
NPI:1023367596
Name:SHEN, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WATERSIDE PLAZA
Mailing Address - Street 2:APT 32E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1124
Mailing Address - Country:US
Mailing Address - Phone:646-334-6380
Mailing Address - Fax:
Practice Address - Street 1:10 WATERSIDE PLAZA
Practice Address - Street 2:APT 32E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1124
Practice Address - Country:US
Practice Address - Phone:646-334-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine