Provider Demographics
NPI:1053493817
Name:CHEN, VIVIAN MIN-LAN (NP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MIN-LAN
Last Name:CHEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PENN PLZ FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119-0899
Mailing Address - Country:US
Mailing Address - Phone:718-808-3089
Mailing Address - Fax:
Practice Address - Street 1:1 PENN PLZ FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0899
Practice Address - Country:US
Practice Address - Phone:718-808-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004412363LF0000X
NYF338220-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS79359Medicare UPIN