Healthcare Provider Details

I. General information

NPI: 1316567878
Provider Name (Legal Business Name): WANQIONG QIAO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MADISON AVE FL 2
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

205 E 95TH ST APT 21C
NEW YORK NY
10128-4071
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-2742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberCQP119171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: