MEDICARE: XIAORONG HE PHYSICIAN PC

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
1	207R00000X	Internal Medicine Physician	199886	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1285813543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XIAORONG HE PHYSICIAN PC

Provider Business Mailing Address
First Line	:	8701 JUSTICE AVE
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4556
Country	:	US
Telephone Number	:	718-699-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 JUSTICE AVE
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4556
Country	:	US
Telephone Number	:	718-699-5283
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. XIAORONG HE
Credential	:	MD
Telephone Number	:	718-699-5283

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	08/27/2008

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