MEDICARE: JADE JIANG NP

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	363LA2200X	Adult Health Nurse Practitioner	311758	NY

General Provider Information

NPI Number	:	1962255513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE JIANG NP

Provider Business Mailing Address
First Line	:	9511 SHORE RD APT 408
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-7541
Country	:	US
Telephone Number	:	917-915-5087
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 RICHMOND AVE STE C
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1527
Country	:	US
Telephone Number	:	718-701-8103
Fax Number	:

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

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/11/2024

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