Basic Information
| Provider Information | |||||||||
| NPI: | 1164010393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | VICKY | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CHEN | ||||||||
| OtherFirstName: | VICKY | ||||||||
| OtherMiddleName: | PIN HUA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1283 YORK AVENUE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100650000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127463607 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1283 YORK AVENUE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100650000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127463607 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2021 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 431747 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.