Provider Demographics
NPI:1952399958
Name:CHEN, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE # 218
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7127
Mailing Address - Country:US
Mailing Address - Phone:973-227-0062
Mailing Address - Fax:973-287-6921
Practice Address - Street 1:1129 BLOOMFIELD AVE
Practice Address - Street 2:SUITE # 218
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7127
Practice Address - Country:US
Practice Address - Phone:973-227-0062
Practice Address - Fax:973-287-6921
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07829700207W00000X
MA213551207W00000X
NY234342-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7024468OtherAETNA
NJ76WEGPQ8085OtherWORKERS COMP
NJ6592649OtherCIGNA
NJ7024468OtherAETNA
NJ6592649OtherCIGNA
MANX2614Medicare UPIN