Individual provider Active NPI

Ling Yan Jiang, P.A

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1578991964
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016804 Issued in NY
Practice address
5604 7TH Ave Ste 1
Brooklyn, NY 11220-4660
Phone
(718) 820-6091
Fax
(718) 450-8919
NPI assigned
Oct 22, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 016804 NY Primary

Addresses

Primary practice location

5604 7TH Ave Ste 1
Brooklyn, NY 11220-4660

Mailing address

5604 7TH Ave Ste 1
Brooklyn, NY 11220-4660
Phone (718) 360-7666

Other identifiers 1

IdentifierTypeStateIssuer
03788149MedicaidNY

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
I20190221002075 NY Practitioner - Physician Assistant 6709125503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Century Dermatology PCGroup PAC ID 1557776739, 9 clinicians

Practice addresses (Care Compare)

1766 Hylan Blvd
Unit B
Staten Island, NY 10305-1933
Phone (347) 973-6888

1927 86TH St
Apt 1
Brooklyn, NY 11214-3153
Phone (347) 509-6888

5604 7TH Ave
Suite 1
Brooklyn, NY 11220-4660
Phone (718) 360-7666

99 Bowery
FL 1
New York, NY 10002-4911
Phone (212) 756-6688

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Century Medical Dermatology PLLC CurrentSince Mar 20, 2025 Accepting new patients
Jian Cui, Dermatology, P.C. PastSince Apr 8, 1998 Accepting new patients
New York University Past Accepting new patients

Locations

5604 7th Ave
Ste 1
Brooklyn, NY 11220
Phone (718) 360-7666

Networks

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

Organizations & group practices 4

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": "1382400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1578991964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5604 7TH AVE STE 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112204660",
            "telephone_number": "718-360-7666",
            "fax_number": "718-450-8919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5604 7TH AVE STE 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112204660",
            "telephone_number": "718-820-6091",
            "fax_number": "718-450-8919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIANG",
        "first_name": "LING YAN",
        "name_prefix": "Miss",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-22",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03788149",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.