1841448974 NPI number — LI JIANG

Table of content: LI JIANG (NPI 1841448974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841448974 NPI number — LI JIANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIANG
Provider First Name:
LI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841448974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
613 COURTYARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08844-4256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-240-8285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 COURTYARD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08844-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-240-8285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  25MA08595400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0228656 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".