Healthcare Provider Details

I. General information

NPI: 1326012998
Provider Name (Legal Business Name): WILLIAM W QIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/02/2024
Certification Date: 10/31/2023
Deactivation Date: 03/27/2023
Reactivation Date: 05/02/2023

III. Provider practice location address

200 TRENTON RD
BROWNS MILLS NJ
08015-1705
US

IV. Provider business mailing address

200 TRENTON RD
BROWNS MILLS NJ
08015-1705
US

V. Phone/Fax

Practice location:
  • Phone: 609-893-6611
  • Fax:
Mailing address:
  • Phone: 609-893-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number228377
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07551800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: