Healthcare Provider Details

I. General information

NPI: 1356839807
Provider Name (Legal Business Name): NINA CHEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

3408 30TH ST APT B24
ASTORIA NY
11106-3006
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5800
  • Fax:
Mailing address:
  • Phone: 646-359-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9231885
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9909236
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: