Healthcare Provider Details

I. General information

NPI: 1811576895
Provider Name (Legal Business Name): QIYUN JIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR
PARAMUS NJ
07652-3515
US

IV. Provider business mailing address

400 FAIRVIEW AVE APT 3C
FORT LEE NJ
07024-3848
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-5220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00380900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: