1154175792 NPI number — EDISON JYANG M.D.

Table of content: EDISON JYANG M.D. (NPI 1154175792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154175792 NPI number — EDISON JYANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JYANG
Provider First Name:
EDISON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JYANG
Provider Other First Name:
PING-FONG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154175792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/22/2024
NPI Reactivation Date:
11/22/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 DATES DRIVE INTERNAL MEDICINE RESIDENCY CAYUGA MEDI
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 DATES DRIVE CAYUGA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-252-3457
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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