Provider Demographics
NPI:1093750069
Name:TAI, QING (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:QING
Middle Name:
Last Name:TAI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3341
Mailing Address - Country:US
Mailing Address - Phone:908-231-1131
Mailing Address - Fax:908-231-1132
Practice Address - Street 1:635 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3341
Practice Address - Country:US
Practice Address - Phone:908-231-1131
Practice Address - Fax:908-231-1132
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0735502081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJY38410Medicare UPIN
NJ074124UE2Medicare PIN