Healthcare Provider Details

I. General information

NPI: 1780881680
Provider Name (Legal Business Name): CHUN CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG 8D
STONY BROOK NY
11790-2552
US

IV. Provider business mailing address

2500 NESCONSET HWY BLDG 8D
STONY BROOK NY
11790-2552
US

V. Phone/Fax

Practice location:
  • Phone: 631-366-4550
  • Fax: 631-366-4556
Mailing address:
  • Phone: 631-366-4550
  • Fax: 631-366-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number244759
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: