Provider Demographics
NPI:1780881680
Name:CHEN, CHUN
Entity type:Individual
Prefix:
First Name:CHUN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BLDG 8D
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2552
Mailing Address - Country:US
Mailing Address - Phone:631-366-4550
Mailing Address - Fax:631-366-4556
Practice Address - Street 1:278 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2915
Practice Address - Country:US
Practice Address - Phone:631-366-4550
Practice Address - Fax:631-366-4556
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02900847Medicaid
NY02900847Medicaid