Provider Demographics
NPI:1952552242
Name:MILLER, JING JIANG (LAC)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:JIANG
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JING
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:600 MAMARONECK AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1635
Mailing Address - Country:US
Mailing Address - Phone:914-843-1052
Mailing Address - Fax:
Practice Address - Street 1:600 MAMARONECK AVE STE 406
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1635
Practice Address - Country:US
Practice Address - Phone:914-843-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000443171100000X
NY003610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003610OtherLISENCE OF ACUPUNCTURE
CT000443OtherLISENCE OF ACUPUNCTURE