Healthcare Provider Details

I. General information

NPI: 1780516351
Provider Name (Legal Business Name): JINGQI LIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 NOSTRAND AVENUE 101
BROOKLYN NY
11235
US

IV. Provider business mailing address

63 AVENUE V # 2RE
BROOKLYN NY
11223-4301
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-1300
  • Fax:
Mailing address:
  • Phone: 646-732-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number005089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: