MEDICARE: VICTOR CHEN PODIATRIST, PC

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	213E00000X	Podiatrist	N004215-1	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	:	1861794174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTOR CHEN PODIATRIST, PC

Provider Business Mailing Address
First Line	:	3354 83RD ST
Second Line	:	SUITE H-01
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1466
Country	:	US
Telephone Number	:	718-335-3495
Fax Number	:	718-335-4513

Provider Business Practice Location Address
First Line	:	3354 83RD ST
Second Line	:	SUITE H-01
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1466
Country	:	US
Telephone Number	:	718-335-3495
Fax Number	:	718-335-4513

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTOR CHEN
Credential	:	DPM
Telephone Number	:	718-335-3495

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	03/07/2012

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