Provider Demographics
NPI:1366981888
Name:JIANG, FENGYU (RNFA)
Entity type:Individual
Prefix:
First Name:FENGYU
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROLLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4533
Mailing Address - Country:US
Mailing Address - Phone:973-876-7187
Mailing Address - Fax:
Practice Address - Street 1:21 ROLLING RIDGE RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4533
Practice Address - Country:US
Practice Address - Phone:973-876-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11389500163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant