Provider Demographics
NPI:1982015673
Name:CHEN CHANG JIAN NP IN FAMILY HEALTH PC
Entity Type:Organization
Organization Name:CHEN CHANG JIAN NP IN FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:JIAN
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:917-282-7683
Mailing Address - Street 1:1832 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2915
Mailing Address - Country:US
Mailing Address - Phone:917-282-7683
Mailing Address - Fax:718-265-3344
Practice Address - Street 1:1740 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2825
Practice Address - Country:US
Practice Address - Phone:718-885-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333761314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03510827Medicaid
NYQ14385Medicare UPIN