Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 307982 | NY |
NPI | 1023350352 |
---|---|
Provider Name | Ching Wei Russell Chen |
First Address | West Islip, NY 11795-3105 |
Second Address | West Islip, NY 11795-3105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 12/03/2021 |