Provider Demographics
NPI:1780842351
Name:AN, JIANQIANG (MD)
Entity type:Individual
Prefix:DR
First Name:JIANQIANG
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JIANQIANG
Other - Middle Name:
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13329 41ST RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3671
Mailing Address - Country:US
Mailing Address - Phone:718-961-6678
Mailing Address - Fax:888-500-2919
Practice Address - Street 1:13329 41ST RD STE 2C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3671
Practice Address - Country:US
Practice Address - Phone:718-961-6678
Practice Address - Fax:888-500-2919
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics