Healthcare Provider Details

I. General information

NPI: 1821262593
Provider Name (Legal Business Name): XIAONA QU ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 WHITE PLAINS RD
BRONX NY
10470-1612
US

IV. Provider business mailing address

89 SCHINDLER WAY
FAIRFIELD NJ
07004-2137
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-9664
  • Fax: 718-944-1623
Mailing address:
  • Phone: 973-960-3025
  • Fax: 973-364-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: