Provider Demographics
NPI:1386744092
Name:SAMUEL K.Z.CHEN, P.A.
Entity type:Organization
Organization Name:SAMUEL K.Z.CHEN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KUANGZONG
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-321-1900
Mailing Address - Street 1:4 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5655
Mailing Address - Country:US
Mailing Address - Phone:732-321-1900
Mailing Address - Fax:
Practice Address - Street 1:760 BOUNB BROOK ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:DUNELLEN
Practice Address - State:NJ
Practice Address - Zip Code:08812
Practice Address - Country:US
Practice Address - Phone:732-321-1900
Practice Address - Fax:732-321-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04945500208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06841Medicare UPIN
NJ536639Medicare ID - Type Unspecified