MEDICARE: JENNIFER JANG NP

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	363LA2200X	Adult Health Nurse Practitioner	F305430-1	NY

General Provider Information

NPI Number	:	1841567864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JANG NP

Provider Business Mailing Address
First Line	:	121 W 20TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-3641
Country	:	US
Telephone Number	:	212-337-9290
Fax Number	:	212-337-9275

Provider Business Practice Location Address
First Line	:	121 W 20TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-3641
Country	:	US
Telephone Number	:	212-337-9290
Fax Number	:	212-337-9275

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

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	11/18/2011

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