Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 309281 | NY |
NPI | 1003310699 |
---|---|
Provider Name | Paul Chen |
First Address | Bronx, NY 10461-2507 |
Second Address | Bronx, NY 10453-4303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 09/08/2021 |