Provider Demographics
NPI:1235259284
Name:CHEN, QIYUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:QIYUAN
Middle Name:
Last Name:CHEN
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:PO BOX 90422
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-0422
Mailing Address - Country:US
Mailing Address - Phone:718-238-3440
Mailing Address - Fax:718-759-1042
Practice Address - Street 1:8701 SHORE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4204
Practice Address - Country:US
Practice Address - Phone:718-238-3440
Practice Address - Fax:718-759-1042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01719800Medicaid
NY20N661Medicare ID - Type Unspecified
NY01719800Medicaid