Provider Demographics
NPI:1376916437
Name:REN, QIFENG (RN)
Entity Type:Individual
Prefix:
First Name:QIFENG
Middle Name:
Last Name:REN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3033
Mailing Address - Country:US
Mailing Address - Phone:718-353-6788
Mailing Address - Fax:718-353-6588
Practice Address - Street 1:906 N 7TH ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3033
Practice Address - Country:US
Practice Address - Phone:718-353-6788
Practice Address - Fax:718-353-6588
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY683641163W00000X
NY309209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse