Provider Demographics
NPI:1730199175
Name:CHEN-MEN EAST BROADWAY DENTAL CENTER LLP
Entity type:Organization
Organization Name:CHEN-MEN EAST BROADWAY DENTAL CENTER LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WEIHSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-766-1901
Mailing Address - Street 1:17 E BROADWAY
Mailing Address - Street 2:SUITE 701 702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:212-766-1901
Mailing Address - Fax:212-766-1902
Practice Address - Street 1:17 E BROADWAY
Practice Address - Street 2:SUITE 701 702
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-766-1901
Practice Address - Fax:212-766-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046965122300000X
NY048136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty