Provider Demographics
NPI:1326093543
Name:JEN, ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:JEN
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 1:3808 UNION ST STE 3D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5544
Mailing Address - Country:US
Mailing Address - Phone:718-670-0006
Mailing Address - Fax:718-701-5883
Practice Address - Street 1:3808 UNION ST STE 3D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5544
Practice Address - Country:US
Practice Address - Phone:718-670-0006
Practice Address - Fax:718-701-5883
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218170207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00669OtherMEDICARE GROUP
NYG40002298 LOtherMEDICARE PTAN