Healthcare Provider Details

I. General information

NPI: 1730492711
Provider Name (Legal Business Name): QINGHUI FENG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 W 11TH ST
BROOKLYN NY
11223-3541
US

IV. Provider business mailing address

2022 W 11TH ST
BROOKLYN NY
11223-3541
US

V. Phone/Fax

Practice location:
  • Phone: 347-686-4787
  • Fax:
Mailing address:
  • Phone: 347-686-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00082700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: