Provider Demographics
NPI:1306969688
Name:CHEN, WEI (LAC, CA)
Entity type:Individual
Prefix:MR
First Name:WEI
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 TENAFLY RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2643
Mailing Address - Country:US
Mailing Address - Phone:201-281-3329
Mailing Address - Fax:201-567-5157
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:201-281-3329
Practice Address - Fax:212-749-1791
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00047200171100000X
NY001307-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001307-1OtherLICENSE #
NJ25MZ00047200OtherLICENSE #