Provider Demographics
NPI:1811439839
Name:DONG, JASON QIANG (NP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:QIANG
Last Name:DONG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:QIANG
Other - Middle Name:
Other - Last Name:DONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2822
Mailing Address - Country:US
Mailing Address - Phone:347-399-6067
Mailing Address - Fax:
Practice Address - Street 1:423 6TH ST
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2822
Practice Address - Country:US
Practice Address - Phone:347-399-6067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687654163W00000X
NY310595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse