Healthcare Provider Details

I. General information

NPI: 1154175792
Provider Name (Legal Business Name): EDISON JYANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PING-FONG JYANG

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 11/22/2024
Certification Date:
Deactivation Date: 11/22/2024
Reactivation Date: 11/22/2024

III. Provider practice location address

101 DATES DRIVE CAYUGA MEDICAL CENTER
ITHACA NY
14850
US

IV. Provider business mailing address

101 DATES DRIVE INTERNAL MEDICINE RESIDENCY CAYUGA MEDI
ITHACA NY
14850
US

V. Phone/Fax

Practice location:
  • Phone: 607-252-3457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: