Basic Information
| Provider Information | |||||||||
| NPI: | 1700910643 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MA | ||||||||
| FirstName: | JIANXIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4228 WINDING CREEK RD | ||||||||
| Address2: | |||||||||
| City: | MANLIUS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131048318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152527434 | ||||||||
| FaxNumber: | 3152530841 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 E GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130214040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152527434 | ||||||||
| FaxNumber: | 3152530841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 12/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 234143 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.