Provider Demographics
NPI:1861627887
Name:JING DENG MD REHABILITATION,PC
Entity Type:Organization
Organization Name:JING DENG MD REHABILITATION,PC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:DENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-365-8989
Mailing Address - Street 1:800 2ND AVE # 610
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4709
Mailing Address - Country:US
Mailing Address - Phone:212-883-8898
Mailing Address - Fax:212-883-6603
Practice Address - Street 1:32 E BROADWAY RM 502
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6891
Practice Address - Country:US
Practice Address - Phone:212-925-8839
Practice Address - Fax:212-226-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212380208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02173628Medicaid
NYG96215Medicare UPIN