Provider Demographics
NPI:1497347801
Name:LUO, QILIE
Entity Type:Individual
Prefix:
First Name:QILIE
Middle Name:
Last Name:LUO
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 1:38-38 147TH STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-9998
Mailing Address - Country:US
Mailing Address - Phone:718-886-5648
Mailing Address - Fax:718-425-9698
Practice Address - Street 1:38-38 147TH STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-9998
Practice Address - Country:US
Practice Address - Phone:718-886-5648
Practice Address - Fax:718-425-9698
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0844678171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist