Provider Demographics
NPI:1285813543
Name:XIAORONG HE PHYSICIAN PC
Entity Type:Organization
Organization Name:XIAORONG HE PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAORONG
Authorized Official - Middle Name:
Authorized Official - Last Name:HE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-699-5283
Mailing Address - Street 1:8701 JUSTICE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4556
Mailing Address - Country:US
Mailing Address - Phone:718-699-5283
Mailing Address - Fax:
Practice Address - Street 1:8701 JUSTICE AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4556
Practice Address - Country:US
Practice Address - Phone:718-699-5283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01723179Medicaid
NY01723179Medicaid