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General NPI Number Information
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NPI Number | 1568910495
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Entity Type | Organization
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Legal Business Name | GENG, MD, LLC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 2097 KLOCKNER RD
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City | HAMILTON
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State | NJ
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Zip | 08690-3416
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Country | US
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Telephone | 609-216-6938
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Fax |
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Provider Business Mailing Address
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Address Line | 2097 KLOCKNER RD BLDG 5
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City | HAMILTON
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State | NJ
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Zip | 08690-3416
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Country | US
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Telephone | 609-216-6938
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. QINGDI GENG
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Credential | MD
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Telephone | 609-216-6938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA08629500
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License Number State | NJ
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