Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 212380 | NY |
NPI | 1114949344 |
---|---|
Provider Name | Dr. Jing Deng |
First Address | Flushing, NY 11355-3241 |
Second Address | Flushing, NY 11355-3241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 01/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02173628 | (05) | NY |
G96215 | (02) | NY |