Provider Demographics
NPI:1700102738
Name:CHEN, CHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHEN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6147
Mailing Address - Country:US
Mailing Address - Phone:813-956-6946
Mailing Address - Fax:
Practice Address - Street 1:306 E 96TH ST
Practice Address - Street 2:APT 12F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3839
Practice Address - Country:US
Practice Address - Phone:813-956-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT55632207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program