Provider Demographics
NPI:1982372405
Name:JANG, ELISABETH HYUNJUNG (FNP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:HYUNJUNG
Last Name:JANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W 150TH ST APT 701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-0017
Mailing Address - Country:US
Mailing Address - Phone:917-951-7428
Mailing Address - Fax:
Practice Address - Street 1:1060 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1715
Practice Address - Country:US
Practice Address - Phone:917-951-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779575163W00000X
NY347684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse