Basic Information
Provider Information
NPI: 1164485306
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHEN
FirstName: JIAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherLastNameType:  
Mailing Information
Address1: 5010 STATE HWY 30
Address2: SUITE 205
City: AMSTERDAM
State: NY
PostalCode: 120107532
CountryCode: US
TelephoneNumber: 5188422663
FaxNumber: 5188424861
Practice Location
Address1: 5010 STATE HWY 30
Address2: SUITE 205
City: AMSTERDAM
State: NY
PostalCode: 120107532
CountryCode: US
TelephoneNumber: 5188422663
FaxNumber: 5188424861
Other Information
ProviderEnumerationDate: 04/10/2006
LastUpdateDate: 10/27/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X260330-1NYY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XS0117X260330-1NYN Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
208600000X200301052NCN Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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