Provider Demographics
NPI:1821010653
Name:CHEN, CHAO (DO)
Entity Type:Individual
Prefix:
First Name:CHAO
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13454 MAPLE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4537
Mailing Address - Country:US
Mailing Address - Phone:718-886-9616
Mailing Address - Fax:718-886-9617
Practice Address - Street 1:13454 MAPLE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4537
Practice Address - Country:US
Practice Address - Phone:718-886-9616
Practice Address - Fax:718-886-9617
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY222752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02198612Medicaid
NY39V681OtherMEDICARE OF BROOKLYN
NY07771Medicare PIN
NY39V681OtherMEDICARE OF BROOKLYN