Provider Demographics
NPI:1447421243
Name:CHIANG, JASON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CHIANG
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 1:1299 CORPORATE DR
Mailing Address - Street 2:APT 1922
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6621
Mailing Address - Country:US
Mailing Address - Phone:848-391-2073
Mailing Address - Fax:
Practice Address - Street 1:1299 CORPORATE DR
Practice Address - Street 2:APT 1922
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6621
Practice Address - Country:US
Practice Address - Phone:848-391-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122166207ZB0001X, 207ZP0105X
NY258827207ZP0105X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine