Provider Demographics
NPI:1619507597
Name:XIAO, EUGENIA YI TONG (RN)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:YI TONG
Last Name:XIAO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FURMAN ST APT 526
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7083
Mailing Address - Country:US
Mailing Address - Phone:718-419-6318
Mailing Address - Fax:
Practice Address - Street 1:717 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3503
Practice Address - Country:US
Practice Address - Phone:718-618-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779645163W00000X
NY310246363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse