Healthcare Provider Details

I. General information

NPI: 1982015673
Provider Name (Legal Business Name): CHEN CHANG JIAN NP IN FAMILY HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 84TH ST
BROOKLYN NY
11214-2825
US

IV. Provider business mailing address

1832 84TH ST
BROOKLYN NY
11214-2915
US

V. Phone/Fax

Practice location:
  • Phone: 718-885-8484
  • Fax:
Mailing address:
  • Phone: 917-282-7683
  • Fax: 718-265-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberF333761
License Number StateNY

VIII. Authorized Official

Name: CHANG JIAN CHEN
Title or Position: OWNER
Credential: FNP
Phone: 917-282-7683