Basic Information
| Provider Information | |||||||||
| NPI: | 1851333611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | LEWAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 679B | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852752475 | ||||||||
| FaxNumber: | 5854730477 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852754751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 08/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 214020 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00025282801 | 01 | NY | UNIVERA | OTHER | 01935506 | 05 | NY | MEDICAID | 1648 | 01 | NY | BLUE SHIELD | OTHER | 2190797 | 01 | NY | INDEPENDENT HEALTH | OTHER | P010214020 | 01 | NY | BLUE CHOICE | OTHER | 060056612 | 01 | NY | MEDICARE RAILROAD | OTHER | 7939242 | 01 | NY | AETNA | OTHER | MDE615 | 01 | NY | PREFERRED CARE | OTHER | 005258441 | 01 | NY | BC/BS OF WESTERN NY | OTHER |