Provider Demographics
NPI:1205128576
Name:CHEN, NICOLA SHIAN JIN (NP)
Entity type:Individual
Prefix:MS
First Name:NICOLA SHIAN JIN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0066
Mailing Address - Country:US
Mailing Address - Phone:347-918-7536
Mailing Address - Fax:212-848-6603
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044-0052
Practice Address - Country:US
Practice Address - Phone:646-686-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305477363LA2200X
NYF340782363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health