Healthcare Provider Details

I. General information

NPI: 1649711375
Provider Name (Legal Business Name): MAGGIE JIANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 38TH AVE STE 5H
FLUSHING NY
11354-4232
US

IV. Provider business mailing address

37 WILTON ST
NEW HYDE PARK NY
11040-3829
US

V. Phone/Fax

Practice location:
  • Phone: 718-661-9554
  • Fax:
Mailing address:
  • Phone: 646-667-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341501-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: