Provider Demographics
NPI:1063285922
Name:CHEN, YONG
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E BROADWAY FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6803
Mailing Address - Country:US
Mailing Address - Phone:917-472-7328
Mailing Address - Fax:917-472-7311
Practice Address - Street 1:58 E BROADWAY FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6803
Practice Address - Country:US
Practice Address - Phone:917-472-7328
Practice Address - Fax:917-472-7311
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0405623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy