MEDICARE: CHENG QIAN PA

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	363A00000X	Physician Assistant	017017	NY

General Provider Information

NPI Number	:	1720416076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHENG QIAN PA

Provider Business Mailing Address
First Line	:	6249 82ND PL
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1904
Country	:	US
Telephone Number	:	646-610-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	6249 82ND PL
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1904
Country	:	US
Telephone Number	:	646-610-3158
Fax Number	:

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

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	10/24/2013

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Directions to “ CHENG QIAN PA” Practice Location

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