Provider Demographics
NPI:1346732666
Name:XU, QIAN
Entity Type:Individual
Prefix:
First Name:QIAN
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17128 PIDGEON MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1137
Mailing Address - Country:US
Mailing Address - Phone:617-413-8097
Mailing Address - Fax:
Practice Address - Street 1:1810 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11356-2221
Practice Address - Country:US
Practice Address - Phone:646-520-7027
Practice Address - Fax:929-242-4312
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007239213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery