Individual
JING SHAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2415 BELL BLVD, BAYSIDE, NY 11360-2222
(718) 357-3638
Mailing address
2415 BELL BLVD, BAYSIDE, NY 11360-2222
(718) 357-3638
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
018320
NY
2251X0800X
Orthopedic Physical Therapist
Primary
018320
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02459814
—
NY
Enumeration date
03/07/2006
Last updated
09/11/2025
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