Provider Demographics
NPI:1831414812
Name:QIAN, JIN (MD)
Entity type:Individual
Prefix:MR
First Name:JIN
Middle Name:
Last Name:QIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 E GENESEE ST
Mailing Address - Street 2:APT 7
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2241
Mailing Address - Country:US
Mailing Address - Phone:631-703-0950
Mailing Address - Fax:
Practice Address - Street 1:52 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1814
Practice Address - Country:US
Practice Address - Phone:914-666-2220
Practice Address - Fax:914-666-2430
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY291063-12085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty