1265978365 NPI number — JIN QIU MD PC

Table of content: (NPI 1265978365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265978365 NPI number — JIN QIU MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIN QIU MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265978365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 E 55TH ST APT 4C
Provider Second Line Business Mailing Address:
APT 4C
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-4050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-201-0268
Provider Business Mailing Address Fax Number:
347-527-9166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 E 55TH ST APT 4C
Provider Second Line Business Practice Location Address:
APT 4C
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-4050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-201-0268
Provider Business Practice Location Address Fax Number:
347-527-9166
Provider Enumeration Date:
01/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
QIU
Authorized Official First Name:
JIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
646-201-0268

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  NY198620 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 198620 . This is a "NYS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA08299200 . This is a "NJ PRACTICE LOCATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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