Provider Demographics
NPI:1528189628
Name:CHEN, JEFFREY G (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:CHEN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BAXTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4461
Mailing Address - Country:US
Mailing Address - Phone:212-925-7105
Mailing Address - Fax:
Practice Address - Street 1:81 BAXTER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4461
Practice Address - Country:US
Practice Address - Phone:212-925-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2G5631OtherEMPIRE
NY001548OtherNYS LICENSED NUMBER