Healthcare Provider Details

I. General information

NPI: 1154841088
Provider Name (Legal Business Name): GUOQIONG QU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GUOQIONG KATHERINE QU MD

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/07/2024
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E BROADWAY UNIT 1C
NEW YORK NY
10002-7188
US

IV. Provider business mailing address

3147 137TH ST STE CF
FLUSHING NY
11354-2667
US

V. Phone/Fax

Practice location:
  • Phone: 646-398-8054
  • Fax: 929-352-4214
Mailing address:
  • Phone: 917-563-1111
  • Fax: 929-352-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number295268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: