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General NPI Number Information
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NPI Number | 1063943314
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Entity Type | Individual
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Provider Name | JESSE JUNCONG XIE MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 518 E 20TH ST
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City | NEW YORK
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State | NY
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Zip | 10009-8330
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Country | US
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Telephone | 646-682-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 518 E 20TH ST
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City | NEW YORK
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State | NY
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Zip | 10009-8330
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Country | US
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Telephone | 646-682-3555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101274650
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 320409
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License Number State | NY
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