Provider Demographics
NPI:1104389402
Name:CHEN, SITONG (DPM)
Entity type:Individual
Prefix:DR
First Name:SITONG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MILLBURN AVE STE 104B
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1712
Mailing Address - Country:US
Mailing Address - Phone:732-532-3668
Mailing Address - Fax:973-577-4003
Practice Address - Street 1:225 MILLBURN AVE STE 104B
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1712
Practice Address - Country:US
Practice Address - Phone:732-889-7946
Practice Address - Fax:973-577-4003
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MD00372100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program