Provider Demographics
NPI:1881099323
Name:JIANG, SELINA
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JIN FENG
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9722 57TH AVE
Mailing Address - Street 2:7J
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3875
Mailing Address - Country:US
Mailing Address - Phone:646-348-0987
Mailing Address - Fax:
Practice Address - Street 1:9722 57TH AVE
Practice Address - Street 2:7J
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3875
Practice Address - Country:US
Practice Address - Phone:646-348-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator