MEDICARE: SOHO VASCULAR SURGERY 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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1780539791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOHO VASCULAR SURGERY PC

Provider Business Mailing Address
First Line	:	41 STILLWATER RD
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-3913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 STILLWATER RD
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-3913
Country	:	US
Telephone Number	:	646-872-6387
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FENG QIN
Credential	:	MD
Telephone Number	:	646-872-6387

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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