Healthcare Provider Details

I. General information

NPI: 1598703266
Provider Name (Legal Business Name): CXC PHYSICIAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MAC LEAN DR
GLEN HEAD NY
11545-3137
US

IV. Provider business mailing address

9 MAC LEAN DR
GLEN HEAD NY
11545-3137
US

V. Phone/Fax

Practice location:
  • Phone: 516-474-2038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. XIAOCHANG JOHHNY CHEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-474-2038