Provider Demographics
NPI:1306219878
Name:JAY, TIANI
Entity Type:Individual
Prefix:
First Name:TIANI
Middle Name:
Last Name:JAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351-3000
Mailing Address - Country:US
Mailing Address - Phone:347-804-1057
Mailing Address - Fax:347-542-5853
Practice Address - Street 1:14202 20TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11351
Practice Address - Country:US
Practice Address - Phone:347-804-1057
Practice Address - Fax:347-542-5853
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist