Provider Demographics
NPI:1770534430
Name:CHEN, CLARENCE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:LEE
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:110 W 96TH ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6413
Mailing Address - Country:US
Mailing Address - Phone:212-595-7189
Mailing Address - Fax:212-595-7189
Practice Address - Street 1:110 W 96TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6413
Practice Address - Country:US
Practice Address - Phone:212-595-7189
Practice Address - Fax:212-595-7189
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1387492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138749OtherMEDICAL LICENSE
NJ59005OtherMEDICAL LICENSE
NY4289903OtherAETNA PROVIDER ID
NYP637365OtherOXFORD PROVIDER ID
NY00712029Medicaid
NY79008946OtherDEPT OF HEALTH PIN
NY0097224OtherGHI PROVIDER ID
NY0097224OtherGHI PROVIDER ID
NJ59005OtherMEDICAL LICENSE
NY00712029Medicaid