MEDICARE: MINGXU XU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	260294	NY

General Provider Information

NPI Number	:	1174820476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINGXU XU M.D.

Provider Business Mailing Address
First Line	:	47 PEACOCK DR
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-2522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 PEACOCK DR
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-2522
Country	:	US
Telephone Number	:	602-710-6834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	03/03/2015

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