Provider Demographics
NPI:1841567864
Name:JANG, JENNIFER (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JIN SUK
Other - Middle Name:
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:121 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3641
Mailing Address - Country:US
Mailing Address - Phone:212-337-9290
Mailing Address - Fax:212-337-9275
Practice Address - Street 1:121 W 20TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3641
Practice Address - Country:US
Practice Address - Phone:212-337-9290
Practice Address - Fax:212-337-9275
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305430-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health