Healthcare Provider Details

I. General information

NPI: 1861627887
Provider Name (Legal Business Name): JING DENG MD REHABILITATION,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E BROADWAY RM 502
NEW YORK NY
10002-6891
US

IV. Provider business mailing address

800 2ND AVE # 610
NEW YORK NY
10017-4709
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8839
  • Fax: 212-226-8498
Mailing address:
  • Phone: 212-883-8898
  • Fax: 212-883-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number212380
License Number StateNY

VIII. Authorized Official

Name: JING DENG
Title or Position: PRESIDENT
Credential: MD
Phone: 212-365-8989