Healthcare Provider Details

I. General information

NPI: 1538691365
Provider Name (Legal Business Name): HE QIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13633 37TH AVE FL 7
FLUSHING NY
11354-4561
US

IV. Provider business mailing address

13633 37TH AVE FL 7
FLUSHING NY
11354-4561
US

V. Phone/Fax

Practice location:
  • Phone: 718-321-3262
  • Fax: 718-321-3263
Mailing address:
  • Phone: 718-321-3262
  • Fax: 718-321-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number320624
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11532400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number320624
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: