Individual provider Active NPI

Jacqueline Pe Chiang, N.P.

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1255533089
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F301461-1 Issued in NY
Practice address
10 Union Square East
Suite 5B
New York, NY 10003
Phone
(212) 844-8775
NPI assigned
Jun 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 26NJ00024600 NJ
Adult Health Nurse Practitioner 363LA2200X 505348 CA
Adult Health Nurse Practitioner 363LA2200X F301461-1 NY Primary

Addresses

Primary practice location

10 Union Square East
Suite 5B
New York, NY 10003

Mailing address

6 Foulet Drive
Princeton, NJ 08540-7638
Phone (609) 252-9603

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201028002464 NY Practitioner - Nurse Practitioner 3476963653 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
505348CAMDAdult Health Nurse Practitioner
26NJ00024600NJMDAdult Health Nurse Practitioner
F301461-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jul 1, 2020 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jul 1, 2020 Accepting new patients

Locations

150 E 42nd St
Frnt D
New York, NY 10017

10 Union Sq E
New York, NY 10003
Phone (212) 253-6800

10 Union Sq E
Ste 5B
New York, NY 10003
Phone (212) 844-6852

Organizations & group practices 3

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": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1255533089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 FOULET DRIVE",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085407638",
            "telephone_number": "609-252-9603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 UNION SQUARE EAST",
            "address_2": "SUITE 5B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10003",
            "telephone_number": "212-844-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHIANG",
        "first_name": "JACQUELINE",
        "middle_name": "PE",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-04",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ00024600",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "505348",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F301461-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.