Provider Demographics
NPI:1073520664
Name:CHEN, SUSIE (MD)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
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:PO BOX 412826
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2526
Mailing Address - Country:US
Mailing Address - Phone:610-892-8889
Mailing Address - Fax:484-446-8005
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:908-522-2065
Practice Address - Fax:908-522-5763
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075735002085R0202X
NY240269-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02186203OtherMEDICAID GROUP #
NYW35021OtherMEDICARE GROUP #
NYW35021OtherMEDICARE GROUP #