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NPI Code Detail

MEDICARE: DR. JACK XIE MD

MEDICARE: DR. JACK XIE MD
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
1207R00000XInternal Medicine Physician125.081855IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1720724412
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK XIE MD
Provider Business Mailing Address
First Line : 475 SEAVIEW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3436
Country : US
Telephone Number : 718-226-9000
Fax Number :
Provider Business Practice Location Address
First Line : 475 SEAVIEW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3436
Country : US
Telephone Number : 773-878-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2022
Last Update Date : 06/17/2026

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