Provider Demographics
NPI:1750477253
Name:CHEN, VICTOR (DPM)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 94TH ST STE 1J
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1931
Mailing Address - Country:US
Mailing Address - Phone:718-335-3495
Mailing Address - Fax:718-429-2186
Practice Address - Street 1:3345 94TH ST STE 1J
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1931
Practice Address - Country:US
Practice Address - Phone:718-335-3495
Practice Address - Fax:718-429-3225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004215-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00043069OtherRAILROAD MEDICARE
NYP45021OtherMEDIARE BC/BS
NY01054897Medicaid
NY34198OtherGHI
NY6411330001OtherDME
NYNYBQ11986OtherNGS MEDICARE
NY4502OtherBC/BS
NYT31866Medicare UPIN
NY4502OtherBC/BS
NY34198Medicare PIN