Healthcare Provider Details

I. General information

NPI: 1922186204
Provider Name (Legal Business Name): RUY CHEN TIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 EAST 17TH STREET
BROOKLYN NY
11229
US

IV. Provider business mailing address

1715 EAST 17TH STREET
BROOKLYN NY
11229
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-1015
  • Fax: 718-375-0810
Mailing address:
  • Phone: 718-336-1015
  • Fax: 718-375-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number184647
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number184647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: