MEDICARE: MS. YI XIA

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	225A00000X	Music Therapist	15129	NJ

General Provider Information

NPI Number	:	1659984359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YI XIA

Provider Business Mailing Address
First Line	:	1300 AVENUE AT PORT IMPERIAL APT 421
Second Line	:
City	:	WEEHAWKEN
State	:	NJ
Zip	:	07086-6966
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 AVENUE AT PORT IMPERIAL APT 421
Second Line	:
City	:	WEEHAWKEN
State	:	NJ
Zip	:	07086-6966
Country	:	US
Telephone Number	:	405-408-6663
Fax Number	:

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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