MEDICARE: TINGTING CHEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	309986	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	721079	OTHER	NY	RN

General Provider Information

NPI Number	:	1184231797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINGTING CHEN NP

Provider Business Mailing Address
First Line	:	78 BROADWAY, MALVERNE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11565
Country	:	US
Telephone Number	:	631-305-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	5618 7TH AVE BROOKLYN
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11220
Country	:	US
Telephone Number	:	631-305-7474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	09/28/2020

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