Provider Demographics
NPI:1104306125
Name:CHEN, DI (MSCPT)
Entity type:Individual
Prefix:
First Name:DI
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MSCPT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSCPT
Mailing Address - Street 1:39 BROADWAY RM 630
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-3075
Mailing Address - Country:US
Mailing Address - Phone:646-588-0082
Mailing Address - Fax:347-644-2747
Practice Address - Street 1:39 BROADWAY RM 630
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3075
Practice Address - Country:US
Practice Address - Phone:646-588-0082
Practice Address - Fax:347-644-2747
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist