Provider Demographics
NPI:1508406901
Name:JING QIAO OB/GYN P.C.
Entity Type:Organization
Organization Name:JING QIAO OB/GYN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:QIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-758-7288
Mailing Address - Street 1:4265 KISSENA BLVD # L3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3273
Mailing Address - Country:US
Mailing Address - Phone:646-758-7288
Mailing Address - Fax:833-983-5651
Practice Address - Street 1:4265 KISSENA BLVD # L3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3273
Practice Address - Country:US
Practice Address - Phone:646-758-7288
Practice Address - Fax:833-983-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12184894OtherCAQH
NY05818566Medicaid