Provider Demographics
NPI:1477710564
Name:XIE, JIANLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIANLIN
Middle Name:
Last Name:XIE
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 1:4160 MAIN ST
Mailing Address - Street 2:201A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3833
Mailing Address - Country:US
Mailing Address - Phone:718-321-8840
Mailing Address - Fax:
Practice Address - Street 1:4160 MAIN ST
Practice Address - Street 2:201A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3833
Practice Address - Country:US
Practice Address - Phone:718-321-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241857207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1Medicaid