Healthcare Provider Details

I. General information

NPI: 1669386330
Provider Name (Legal Business Name): JUSTIN QU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 UNION ST STE 3
BROOKLYN NY
11215-7724
US

IV. Provider business mailing address

794 UNION ST STE 3
BROOKLYN NY
11215-7724
US

V. Phone/Fax

Practice location:
  • Phone: 646-841-1402
  • Fax: 212-379-2097
Mailing address:
  • Phone: 646-841-1402
  • Fax: 212-379-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: