Provider Demographics
NPI:1477512150
Name:FANG, QIANG GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:QIANG
Middle Name:GARY
Last Name:FANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 TUDOR OVAL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2244
Mailing Address - Country:US
Mailing Address - Phone:646-251-2952
Mailing Address - Fax:212-951-6359
Practice Address - Street 1:423 E 23RD ST # PM&R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5011
Practice Address - Country:US
Practice Address - Phone:646-251-2952
Practice Address - Fax:212-951-6359
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11648000208100000X
CAA81489208100000X
NY220607208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02148754Medicaid
NY0564J1Medicare ID - Type Unspecified
NY02148754Medicaid