MEDICARE: XUE XU

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	163W00000X	Registered Nurse	735722	NY
2	363L00000X	Nurse Practitioner	354510	NY

General Provider Information

NPI Number	:	1417455569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XUE XU

Provider Business Mailing Address
First Line	:	4199 MAIN ST STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5164
Country	:	US
Telephone Number	:	718-961-1897
Fax Number	:

Provider Business Practice Location Address
First Line	:	4199 MAIN ST STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5164
Country	:	US
Telephone Number	:	718-961-1897
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	10/22/2024

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Directions to “ XUE XU ” Practice Location

Language	Start Address	Practice Location

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