Provider Demographics
NPI:1336499417
Name:FENG, JIA MIN (RPA-C)
Entity Type:Individual
Prefix:
First Name:JIA
Middle Name:MIN
Last Name:FENG
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:FENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13259 41ST RD
Mailing Address - Street 2:SUITE 1A &1B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4257
Mailing Address - Country:US
Mailing Address - Phone:718-358-3535
Mailing Address - Fax:
Practice Address - Street 1:13259 41ST RD
Practice Address - Street 2:SUITE #1A & 1B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4257
Practice Address - Country:US
Practice Address - Phone:718-358-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015949363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74120275900Medicaid