MEDICARE: CHINATOWN TRUE CARE MEDICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	230444	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417194507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINATOWN TRUE CARE MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	139 CENTRE ST STE 711
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4557
Country	:	US
Telephone Number	:	631-220-1581
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 UNION ST STE 3L
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5670
Country	:	US
Telephone Number	:	718-939-5213
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HAIFAN CHEN
Credential	:	M.D.,D.O.
Telephone Number	:	718-939-5213

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	06/16/2021

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