MEDICARE: ITAY CHEN

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	207Y00000X	Otolaryngology Physician	P113214	NY

General Provider Information

NPI Number	:	1881313815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITAY CHEN

Provider Business Mailing Address
First Line	:	2516 HUBBARD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6223
Country	:	US
Telephone Number	:	347-374-1758
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 HUBBARD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6223
Country	:	US
Telephone Number	:	347-374-1758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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Directions to “ ITAY CHEN ” Practice Location

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