Healthcare Provider Details

I. General information

NPI: 1871125955
Provider Name (Legal Business Name): QINGJIE WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

155 BORTHWICK AVE STE 200E
PORTSMOUTH NH
03801-4184
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-3937
  • Fax:
Mailing address:
  • Phone: 603-436-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD30289
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD30289
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number39220
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39220
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number328959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: