Provider Demographics
NPI:1437507779
Name:GT MEDICAL PC
Entity Type:Organization
Organization Name:GT MEDICAL PC
Other - Org Name:QUEENS MEDICAL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QIAO
Authorized Official - Middle Name:DONG
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-947-7692
Mailing Address - Street 1:9436 58TH AVE # G4
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5149
Mailing Address - Country:US
Mailing Address - Phone:347-947-7692
Mailing Address - Fax:
Practice Address - Street 1:9436 58TH AVE # G4
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:347-947-7692
Practice Address - Fax:347-947-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269058207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760624423OtherNPI