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1902805740

NPI Code Detail

MEDICARE: DR. ALICE CHEN MD

MEDICARE: DR. ALICE CHEN MD

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	171100000X	Acupuncturist	040703	CT
2	208VP0000X	Pain Medicine Physician	040703	CT
3	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	040703	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	214243	OTHER	NY	STATE LICENSE
2	40703	OTHER	CT	STATE LICENSE

General Provider Information

NPI Number	:	1902805740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE CHEN MD

Provider Business Mailing Address
First Line	:	PO BOX 626
Second Line	:
City	:	GREAT RIVER
State	:	NY
Zip	:	11739-0626
Country	:	US
Telephone Number	:	203-705-2087
Fax Number	:	203-705-2927

Provider Business Practice Location Address
First Line	:	1 BLACHLEY RD
Second Line	:	HOSPITAL FOR SPECIAL SURGERY
City	:	STAMFORD
State	:	CT
Zip	:	06902-0002
Country	:	US
Telephone Number	:	203-705-2087
Fax Number	:	203-705-2927

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	11/01/2024

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Directions to “ DR. ALICE CHEN MD” Practice Location

Language	Start Address	Practice Location

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