Healthcare Provider Details

I. General information

NPI: 1922984590
Provider Name (Legal Business Name): XIAO TONG CHEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE APT 1C
BRONX NY
10457-7628
US

IV. Provider business mailing address

3 COURT SQ APT 521
LONG ISLAND CITY NY
11101-8907
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: