Provider Demographics
NPI:1134199920
Name:GAN, JIANGPING
Entity type:Individual
Prefix:
First Name:JIANGPING
Middle Name:
Last Name:GAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 MAPLE AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3865
Mailing Address - Country:US
Mailing Address - Phone:718-939-8890
Mailing Address - Fax:718-939-2070
Practice Address - Street 1:13630 MAPLE AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3865
Practice Address - Country:US
Practice Address - Phone:718-939-8890
Practice Address - Fax:718-939-2070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02597506Medicaid
NYI22577Medicare UPIN
NY06779Medicare ID - Type Unspecified