Healthcare Provider Details

I. General information

NPI: 1255533089
Provider Name (Legal Business Name): JACQUELINE PE CHIANG N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQUARE EAST SUITE 5B
NEW YORK NY
10003
US

IV. Provider business mailing address

6 FOULET DRIVE
PRINCETON NJ
08540-7638
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8775
  • Fax:
Mailing address:
  • Phone: 609-252-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00024600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number505348
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301461-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: