Provider Demographics
NPI:1508891284
Name:CHEN, SAMUEL KUANGZONG (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KUANGZONG
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:K Z
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4 MILLER LANE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059
Mailing Address - Country:US
Mailing Address - Phone:732-563-6948
Mailing Address - Fax:
Practice Address - Street 1:760 BOUNB BROOK ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:DUNELLEN
Practice Address - State:NJ
Practice Address - Zip Code:08812
Practice Address - Country:US
Practice Address - Phone:732-321-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04945500208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06841Medicare UPIN