Provider Demographics
NPI:1225132533
Name:DIEP, JENNY TIEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:TIEN
Last Name:DIEP
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 1:1088 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1132
Mailing Address - Country:US
Mailing Address - Phone:212-860-4000
Mailing Address - Fax:212-722-7365
Practice Address - Street 1:1088 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1132
Practice Address - Country:US
Practice Address - Phone:212-860-4000
Practice Address - Fax:212-722-7365
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25099207RR0500X
NY230002207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4284F1Medicare PIN
I49957Medicare UPIN