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General NPI Number Information
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NPI Number | 1104336957
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Entity Type | Individual
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Provider Name | QIONG CHEN OD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 223 STATE ROUTE 18 STE 107
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1913
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Country | US
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Telephone | 732-247-2847
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Fax | 732-246-2650
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Provider Business Mailing Address
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Address Line | 223 STATE ROUTE 18 STE 107
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1913
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Country | US
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Telephone | 570-468-7249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV008697
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License Number State | NY
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