Provider Demographics
NPI:1982600169
Name:CHEN, KARL TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:TIMOTHY
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 1:620 CRANBURY RD
Mailing Address - Street 2:STE 215
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4000
Mailing Address - Country:US
Mailing Address - Phone:732-613-9335
Mailing Address - Fax:732-613-9235
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:STE 215
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4000
Practice Address - Country:US
Practice Address - Phone:732-613-9335
Practice Address - Fax:732-613-9235
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-06-01
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NJMA69357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG94708Medicare UPIN
NJ027876Medicare ID - Type Unspecified