Individual
JACKY CHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4077 WEST RD, CORTLAND, NY 13045-1637
(607) 753-9977
(607) 218-6276
Mailing address
PO BOX 627, CORTLAND, NY 13045-0627
(607) 758-8019
(607) 758-8210
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
294629
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/29/2015
Last updated
03/04/2021
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