Healthcare Provider Details

I. General information

NPI: 1679333835
Provider Name (Legal Business Name): ALIEJA N CHEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 MAIN ST
MANCHESTER CT
06042-3556
US

IV. Provider business mailing address

191 MAIN ST STE 3
MANCHESTER CT
06042-3574
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-7704
  • Fax:
Mailing address:
  • Phone: 860-646-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6678
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: