Provider Demographics
NPI:1861794174
Name:VICTOR CHEN PODIATRIST, PC
Entity type:Organization
Organization Name:VICTOR CHEN PODIATRIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-335-3495
Mailing Address - Street 1:3354 83RD ST
Mailing Address - Street 2:SUITE H-01
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1466
Mailing Address - Country:US
Mailing Address - Phone:718-335-3495
Mailing Address - Fax:718-335-4513
Practice Address - Street 1:3354 83RD ST
Practice Address - Street 2:SUITE H-01
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1466
Practice Address - Country:US
Practice Address - Phone:718-335-3495
Practice Address - Fax:718-335-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004215-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01054897Medicaid
NY01054897Medicaid
6411330001Medicare NSC
NYBQ11986Medicare PIN