Provider Demographics
NPI:1073172441
Name:FENG, QINGSHAN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:QINGSHAN
Middle Name:
Last Name:FENG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 223RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1935
Mailing Address - Country:US
Mailing Address - Phone:917-518-0679
Mailing Address - Fax:
Practice Address - Street 1:5701 223RD ST FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1935
Practice Address - Country:US
Practice Address - Phone:917-518-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006476171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006476OtherACUPUNCTURIST