Basic Information
Provider Information
NPI: 1003139304
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHON
FirstName: HELEN
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 21409 WATERS EDGE DR
Address2:  
City: BAYSIDE
State: NY
PostalCode: 113601205
CountryCode: US
TelephoneNumber: 2673347025
FaxNumber:  
Practice Location
Address1: 14246 ROOSEVELT AVE
Address2:  
City: FLUSHING
State: NY
PostalCode: 113546042
CountryCode: US
TelephoneNumber: 7188880808
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/02/2010
LastUpdateDate: 03/02/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X051451NYY Pharmacy Service ProvidersPharmacist 

No ID Information.


Home