Healthcare Provider Details

I. General information

NPI: 1114763026
Provider Name (Legal Business Name): ERIC CHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CATHERWOOD RD STE F17
ITHACA NY
14850-1056
US

IV. Provider business mailing address

30 RIVER RD
BOONTON TOWNSHIP NJ
07005-9195
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-2032
  • Fax:
Mailing address:
  • Phone: 973-955-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: