MEDICARE: JIN QIU MD PC

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	261QP2300X	Primary Care Clinic/Center	NY198620	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	198620	OTHER	NY	NYS
2	25MA08299200	OTHER	NJ	NJ PRACTICE LOCATION

General Provider Information

NPI Number	:	1265978365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIN QIU MD PC

Provider Business Mailing Address
First Line	:	141 E 55TH ST APT 4C
Second Line	:	APT 4C
City	:	NEW YORK
State	:	NY
Zip	:	10022-4050
Country	:	US
Telephone Number	:	646-201-0268
Fax Number	:	347-527-9166

Provider Business Practice Location Address
First Line	:	141 E 55TH ST APT 4C
Second Line	:	APT 4C
City	:	NEW YORK
State	:	NY
Zip	:	10022-4050
Country	:	US
Telephone Number	:	646-201-0268
Fax Number	:	347-527-9166

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIN QIU
Credential	:	M.D.
Telephone Number	:	646-201-0268

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	01/12/2017

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