Healthcare Provider Details

I. General information

NPI: 1649191750
Provider Name (Legal Business Name): JIA MING MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

29 REDFERN DR
ROCHESTER NY
14620-4617
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-3450
  • Fax:
Mailing address:
  • Phone: 585-978-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: