Provider Demographics
NPI:1558983916
Name:LIANG, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 ELDERT LN
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2836
Mailing Address - Country:US
Mailing Address - Phone:718-913-6837
Mailing Address - Fax:
Practice Address - Street 1:17 W JOHN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1045
Practice Address - Country:US
Practice Address - Phone:516-935-2067
Practice Address - Fax:516-935-2017
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist