Individual provider Active NPI

Jiang Wang, DO

  • Family Medicine Physician
  • Flushing, NY
National Provider Identifier
1174010425
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
310023 Issued in NY
Practice address
Cbwchc 131-72 40TH Rd
Flushing, NY 11354
Phone
(718) 587-1111
Fax
(718) 886-3903
NPI assigned
Apr 21, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 310023 NY Primary

Addresses

Primary practice location

Cbwchc 131-72 40TH Rd
Flushing, NY 11354

Mailing address

131-72 40TH Rd
3 FL
Flushing, NY 11354
Phone (718) 587-1111

Other practice location 1

13620 Maple Ave Ste 303
Flushing, NY 11355-5167
Phone (718) 210-3688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220106000190 NY Practitioner - Family Practice 1052724614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Touro Un Col of Osteopathic Medicine, New York, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

13620 Maple Ave
Flushing, NY 11355-3824
Phone (917) 348-0698

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: jwang787764@direct.ochin.org
  • Direct secure messaging: jianwang@1120.direct.myezyaccess.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1174010425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131-72 40TH RD",
            "address_2": "3 FL",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11354",
            "telephone_number": "718-587-1111",
            "fax_number": "718-886-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CBWCHC 131-72 40TH RD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11354",
            "telephone_number": "718-587-1111",
            "fax_number": "718-886-3903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13620 Maple Ave Ste 303",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113555167",
            "country_code": "US",
            "telephone_number": "718-210-3688",
            "fax_number": "718-210-3683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "JIANG",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-21",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "310023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.