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NPI Code Detail

MEDICARE: CHIXIN FANG M.D.

MEDICARE: CHIXIN FANG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician234095NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043239528
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHIXIN FANG M.D.
Provider Business Mailing Address
First Line : 95 SPARKILL AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10304-3135
Country : US
Telephone Number : 718-439-7288
Fax Number : 718-439-0788
Provider Business Practice Location Address
First Line : 730 58TH ST # 1A
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-3917
Country : US
Telephone Number : 718-439-7288
Fax Number : 718-439-0788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 12/12/2011

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