Healthcare Provider Details

I. General information

NPI: 1144410671
Provider Name (Legal Business Name): HERBERT CHIN RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 01 30 AVE #400
ASTORIA NY
11103
US

IV. Provider business mailing address

35 01 30 AVENUE #400
ASTORIA NY
11103
US

V. Phone/Fax

Practice location:
  • Phone: 718-726-7000
  • Fax: 718-335-1791
Mailing address:
  • Phone: 718-726-7000
  • Fax: 718-335-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000173-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: