Provider Demographics
NPI:1356760714
Name:CHEN, JERRALD JINGYI (MD)
Entity type:Individual
Prefix:
First Name:JERRALD
Middle Name:JINGYI
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 HILLTOP BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2836
Mailing Address - Country:US
Mailing Address - Phone:609-235-5487
Mailing Address - Fax:
Practice Address - Street 1:2801 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1828
Practice Address - Country:US
Practice Address - Phone:302-655-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10356700208100000X
DEC1-0013714208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation