MEDICARE: YUANLI XIE MEDICAL 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

General Provider Information

NPI Number	:	1881158897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YUANLI XIE MEDICAL PC

Provider Business Mailing Address
First Line	:	1664 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5135
Country	:	US
Telephone Number	:	347-268-5286
Fax Number	:

Provider Business Practice Location Address
First Line	:	8504 21ST AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3208
Country	:	US
Telephone Number	:	347-766-2262
Fax Number	:	718-676-5365

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN
Name	:	DR. YUANLI XIE
Credential	:	MD
Telephone Number	:	347-268-5286

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	03/24/2021

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