Provider Demographics
NPI:1225121072
Name:TENG, JIANYE (MD)
Entity Type:Individual
Prefix:
First Name:JIANYE
Middle Name:
Last Name:TENG
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 1:111 DANBERRY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 MAIN ST.
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492
Practice Address - Country:US
Practice Address - Phone:315-736-9337
Practice Address - Fax:315-624-5152
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY218669Medicaid
RA6406Medicare PIN
H27371Medicare UPIN