Provider Demographics
NPI:1801080189
Name:DR. BOJUN CHEN'S MEDICAL REHAB, P.C.
Entity type:Organization
Organization Name:DR. BOJUN CHEN'S MEDICAL REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-321-7290
Mailing Address - Street 1:17 CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1199
Mailing Address - Country:US
Mailing Address - Phone:718-663-4826
Mailing Address - Fax:718-321-7289
Practice Address - Street 1:13237 41ST RD
Practice Address - Street 2:ROOM 103
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4242
Practice Address - Country:US
Practice Address - Phone:718-321-7290
Practice Address - Fax:718-321-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220919208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04611BOtherGHI MEDICARE
NY02205769Medicaid
NY02205769Medicaid