Provider Demographics
NPI:1225102791
Name:LIANG, JIAN Q (DPM)
Entity Type:Individual
Prefix:
First Name:JIAN
Middle Name:Q
Last Name:LIANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4552
Mailing Address - Country:US
Mailing Address - Phone:212-619-2539
Mailing Address - Fax:212-871-0020
Practice Address - Street 1:139 CENTRE STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4553
Practice Address - Country:US
Practice Address - Phone:212-619-2539
Practice Address - Fax:212-871-0020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005666213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146601Medicaid
NYA400056021Medicare PIN
U84836Medicare UPIN