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General NPI Number Information
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NPI Number | 1477512150
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Entity Type | Individual
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Provider Name | QIANG GARY FANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 423 E 23RD ST # PM&R
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City | NEW YORK
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State | NY
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Zip | 10010-5011
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Country | US
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Telephone | 646-251-2952
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Fax | 212-951-6359
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Provider Business Mailing Address
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Address Line | 151 TUDOR OVAL
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City | WESTFIELD
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State | NJ
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Zip | 07090-2244
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Country | US
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Telephone | 646-251-2952
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Fax | 212-951-6359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA11648000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A81489
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 220607
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License Number State | NY
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