MEDICARE: JIANG HE

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	251S00000X	Community/Behavioral Health Agency	61-1792794	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61-1792794	OTHER		HEALTH GROCERIES

General Provider Information

NPI Number	:	1912614447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIANG HE

Provider Business Mailing Address
First Line	:	13357 ROOSEVELT AVE FL 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5254
Country	:	US
Telephone Number	:	646-226-4582
Fax Number	:

Provider Business Practice Location Address
First Line	:	13357 ROOSEVELT AVE FL 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5254
Country	:	US
Telephone Number	:	646-226-4582
Fax Number	:

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

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	11/03/2022

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Directions to “ JIANG HE ” Practice Location

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