Healthcare Provider Details

I. General information

NPI: 1407788276
Provider Name (Legal Business Name): JIAN WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 HOMECREST AVE APT 1H
BROOKLYN NY
11235-4532
US

IV. Provider business mailing address

2645 HOMECREST AVE APT 1H
BROOKLYN NY
11235-4532
US

V. Phone/Fax

Practice location:
  • Phone: 646-309-3748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: