1417108440 NPI number — DR. NIU NIU M.D.

Table of content: DR. NIU NIU M.D. (NPI 1417108440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417108440 NPI number — DR. NIU NIU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIU
Provider First Name:
NIU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1417108440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140-31 CHERRY AVE.
Provider Second Line Business Mailing Address:
APT 1A
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11355-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-353-9088
Provider Business Mailing Address Fax Number:
718-353-9087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140-31 CHERRY AVE.
Provider Second Line Business Practice Location Address:
APT 1A
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-353-9088
Provider Business Practice Location Address Fax Number:
718-353-9087
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225400000X , with the licence number:  250671 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 250671 , 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: 03036766 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com