Basic Information
Provider Information | |||||||||
NPI: | 1578540597 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHEN | ||||||||
FirstName: | DONGHUI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 908 NIAGARA FALLS BLVD | ||||||||
Address2: | SUITE 208 | ||||||||
City: | NORTH TONAWANDA | ||||||||
State: | NY | ||||||||
PostalCode: | 141202019 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7166922160 | ||||||||
FaxNumber: | 7162130935 | ||||||||
Practice Location | |||||||||
Address1: | 116 INTERSTATE PKWY | ||||||||
Address2: |   | ||||||||
City: | BRADFORD | ||||||||
State: | PA | ||||||||
PostalCode: | 167011036 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8143628674 | ||||||||
FaxNumber: | 8143628695 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/30/2005 | ||||||||
LastUpdateDate: | 08/19/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA07744800 | NJ | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207LP2900X | MD447217 | PA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 5396850 | 05 | NJ |   | MEDICAID |