Healthcare Provider Details

I. General information

NPI: 1043912272
Provider Name (Legal Business Name): ALICE SOFIE CHEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6981
  • Fax: 718-918-5007
Mailing address:
  • Phone: 718-918-6981
  • Fax: 718-918-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDOSR-603
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: