MEDICARE: QIYUN JENNIFER JIANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	25MD00380900	NJ

General Provider Information

NPI Number	:	1811576895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QIYUN JENNIFER JIANG

Provider Business Mailing Address
First Line	:	400 FAIRVIEW AVE APT 3C
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-3848
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-3420
Country	:	US
Telephone Number	:	201-662-8700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	01/06/2026

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