Basic Information
| Provider Information | |||||||||
| NPI: | 1457722696 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHEN NEIGHBORHOOD MEDICAL NORTH LAUDERDALE LLC | ||||||||
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| OtherOrganizationName: | CHEN MEDICAL ASSOCIATES INC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056286117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6037 KIMBERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330682811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543798994 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2015 | ||||||||
| LastUpdateDate: | 10/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHEN | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3056210023 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.