Provider Demographics
NPI:1841421740
Name:CHEN, SHOW-YAO
Entity Type:Individual
Prefix:
First Name:SHOW-YAO
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21717 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1328
Mailing Address - Country:US
Mailing Address - Phone:718-631-0469
Mailing Address - Fax:
Practice Address - Street 1:3811 DYRE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-6112
Practice Address - Country:US
Practice Address - Phone:718-325-1355
Practice Address - Fax:718-325-1356
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid