1912904269 NPI number — XIN QUAN MEDICAL REHABILITATION AND ACUPUNCTURE, PLLC

Table of content: (NPI 1912904269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912904269 NPI number — XIN QUAN MEDICAL REHABILITATION AND ACUPUNCTURE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
XIN QUAN MEDICAL REHABILITATION AND ACUPUNCTURE, PLLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1912904269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 BAKER AVENUE
Provider Second Line Business Mailing Address:
PROF. UNITE #2
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10601-1635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-285-3480
Provider Business Mailing Address Fax Number:
914-285-3479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 BAKER AVENUE
Provider Second Line Business Practice Location Address:
PROF. UNITE # 2
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10601-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-285-3480
Provider Business Practice Location Address Fax Number:
914-285-3479
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
QUAN
Authorized Official First Name:
XIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
914-285-3480

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  220271 , 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: 7117637 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2465872 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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