Provider Demographics
NPI:1023402260
Name:XIA, TIAN (MD)
Entity Type:Individual
Prefix:
First Name:TIAN
Middle Name:
Last Name:XIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 E NORTHFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-716-0123
Mailing Address - Fax:973-716-0441
Practice Address - Street 1:349 E NORTHFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-716-0123
Practice Address - Fax:973-716-0441
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466729207WX0107X, 207WX0107X
NJ25MA11022100207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0833789Medicaid