Basic Information
Provider Information
NPI: 1316387905
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: LEON
MiddleName: LIN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
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Mailing Information
Address1: 320 E 42ND ST APT 1003
Address2:  
City: NEW YORK
State: NY
PostalCode: 100175962
CountryCode: US
TelephoneNumber: 7186901639
FaxNumber:  
Practice Location
Address1: 1275 YORK AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100656007
CountryCode: US
TelephoneNumber: 2126392000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/27/2013
LastUpdateDate: 06/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X430732NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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