Provider Demographics
NPI:1912258732
Name:CHEN, JENNIFER (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25614 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1647
Mailing Address - Country:US
Mailing Address - Phone:917-826-0485
Mailing Address - Fax:
Practice Address - Street 1:25614 83RD AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1647
Practice Address - Country:US
Practice Address - Phone:917-826-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist