Provider Demographics
NPI:1417108440
Name:NIU, NIU (MD)
Entity Type:Individual
Prefix:DR
First Name:NIU
Middle Name:
Last Name:NIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140-31 CHERRY AVE.
Mailing Address - Street 2:APT 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3168
Mailing Address - Country:US
Mailing Address - Phone:718-353-9088
Mailing Address - Fax:718-353-9087
Practice Address - Street 1:140-31 CHERRY AVE.
Practice Address - Street 2:APT 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3168
Practice Address - Country:US
Practice Address - Phone:718-353-9088
Practice Address - Fax:718-353-9087
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250671225400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03036766Medicaid