Provider Demographics
NPI:1164485306
Name:SHEN, JIAN (MD)
Entity Type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1096
Mailing Address - Country:US
Mailing Address - Phone:518-708-6300
Mailing Address - Fax:518-874-0937
Practice Address - Street 1:1202 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1096
Practice Address - Country:US
Practice Address - Phone:518-708-6300
Practice Address - Fax:518-874-0937
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260330-1207XS0117X, 207X00000X
NC200301052208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35827Medicare UPIN
J400049975Medicare PIN
2042169Medicare PIN