Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22DI02106700 | NJ |
NPI | 1043349079 |
---|---|
Provider Name | Jeffrey Chen |
First Address | Ridgewood, NJ 07450-3197 |
Second Address | Ridgewood, NJ 07450-3197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |