Provider Demographics
NPI:1124623368
Name:LEUNG, JANE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LEUNG
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ELLENSUE DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1008
Mailing Address - Country:US
Mailing Address - Phone:646-835-9355
Mailing Address - Fax:
Practice Address - Street 1:7568 187TH ST FL 1
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1726
Practice Address - Country:US
Practice Address - Phone:718-303-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431708363L00000X
NY431798363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty