Basic Information
| Provider Information | |||||||||
| NPI: | 1164485306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEN | ||||||||
| FirstName: | JIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 TROY SCHENECTADY RD | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121101096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187086300 | ||||||||
| FaxNumber: | 5188740937 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 TROY SCHENECTADY RD | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121101096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187086300 | ||||||||
| FaxNumber: | 5188740937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 260330-1 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 208600000X | 200301052 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 207X00000X | 260330-1 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.