Provider Demographics
NPI:1841864618
Name:TANG, JIALEI (LAC)
Entity type:Individual
Prefix:
First Name:JIALEI
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6844 SPRINGFIELD BLVD UPPR
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2633
Mailing Address - Country:US
Mailing Address - Phone:516-387-5086
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE RM 800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0824
Practice Address - Country:US
Practice Address - Phone:516-387-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006260171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist