Provider Demographics
NPI:1124287826
Name:JEAN CHEN MEDICAL LLP
Entity type:Organization
Organization Name:JEAN CHEN MEDICAL LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-226-6780
Mailing Address - Street 1:PO BOX 520569
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-0569
Mailing Address - Country:US
Mailing Address - Phone:718-886-0066
Mailing Address - Fax:718-886-6985
Practice Address - Street 1:265 CANAL ST
Practice Address - Street 2:416
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-6010
Practice Address - Country:US
Practice Address - Phone:212-226-6780
Practice Address - Fax:212-226-6299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEAN CHEN MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02230399Medicaid
NY02230399Medicaid