Provider Demographics
NPI:1902805740
Name:CHEN, ALICE (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 BLACHLEY RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-0002
Mailing Address - Country:US
Mailing Address - Phone:631-329-6925
Mailing Address - Fax:203-705-2927
Practice Address - Street 1:1 BLACHLEY RD
Practice Address - Street 2:HOSPITAL FOR SPECIAL SURGERY
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-0002
Practice Address - Country:US
Practice Address - Phone:203-705-2087
Practice Address - Fax:203-705-2927
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040703171100000X, 208VP0000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No171100000XOther Service ProvidersAcupuncturist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400062972Medicare PIN
CTD400063866Medicare PIN
CTH29373Medicare UPIN