Healthcare Provider Details

I. General information

NPI: 1316503832
Provider Name (Legal Business Name): DISI CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 06/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 IRVING AVE STE 090
SYRACUSE NY
13210
US

IV. Provider business mailing address

475 IRVING AVE STE 090
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-6323
  • Fax: 315-464-7218
Mailing address:
  • Phone: 315-464-6323
  • Fax: 315-464-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number314865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: