Healthcare Provider Details

I. General information

NPI: 1598732620
Provider Name (Legal Business Name): JING SHAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 BELL BLVD
BAYSIDE NY
11360-2222
US

IV. Provider business mailing address

2415 BELL BLVD
BAYSIDE NY
11360-2222
US

V. Phone/Fax

Practice location:
  • Phone: 718-357-3638
  • Fax:
Mailing address:
  • Phone: 718-357-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number018320
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number018320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: