Healthcare Provider Details

I. General information

NPI: 1174572440
Provider Name (Legal Business Name): YA LI CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ALEXANDER ST MONROE COURT
ROCHESTER NY
14607-4039
US

IV. Provider business mailing address

222 ALEXANDER ST MONROE COURT
ROCHESTER NY
14607-4039
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8350
  • Fax: 585-922-8355
Mailing address:
  • Phone: 585-922-8350
  • Fax: 585-922-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number236357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: