Healthcare Provider Details

I. General information

NPI: 1588168868
Provider Name (Legal Business Name): JEFFERSON CHAOYU CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 5
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

222 E 41ST ST FL 5
NEW YORK NY
10017-6739
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number25MA12628600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number301409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: