Provider Demographics
NPI:1417194507
Name:CHINATOWN TRUE CARE MEDICAL, PLLC
Entity Type:Organization
Organization Name:CHINATOWN TRUE CARE MEDICAL, PLLC
Other - Org Name:RENDR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAIFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DO
Authorized Official - Phone:718-939-5213
Mailing Address - Street 1:139 CENTRE ST STE 711
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4557
Mailing Address - Country:US
Mailing Address - Phone:631-220-1581
Mailing Address - Fax:
Practice Address - Street 1:3808 UNION ST STE 3L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5670
Practice Address - Country:US
Practice Address - Phone:718-939-5213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHINATOWN TRUE CARE MEDICAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-12
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02590412Medicaid
NYI19655Medicare UPIN