Healthcare Provider Details

I. General information

NPI: 1700277019
Provider Name (Legal Business Name): CYNTHIA CHEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLOUGHBY STREET SUITE 8E
BROOKLYN NY
11201
US

IV. Provider business mailing address

121 DEKALB AVE SURGERY DEPT
BROOKLYN NY
11201-2205
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-6920
  • Fax: 718-250-6080
Mailing address:
  • Phone: 718-250-6839
  • Fax: 718-250-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number300144-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: