Provider Demographics
NPI:1477505667
Name:CHEN, BOJUN (MD)
Entity Type:Individual
Prefix:
First Name:BOJUN
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 1:17 CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1199
Mailing Address - Country:US
Mailing Address - Phone:718-321-7290
Mailing Address - Fax:718-358-8097
Practice Address - Street 1:13237 41ST RD
Practice Address - Street 2:ROOM 103
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4242
Practice Address - Country:US
Practice Address - Phone:718-321-7290
Practice Address - Fax:718-321-7289
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2209192081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04611GOtherGHI-MEDICARE
NYP3192510OtherOXFORD HEALTH PLAN
NY2159201OtherUNITED HEALTHCARE
NY22091901OtherNEIGHBORHOOD
NY02205769Medicaid
NY9836330OtherCIGNA
NYP3192510OtherOXFORD HEALTH PLAN
NY422H11Medicare ID - Type UnspecifiedEMPIRE (MANHATTAN)