Provider Demographics
NPI:1619966892
Name:NIE, GUO (MD)
Entity Type:Individual
Prefix:
First Name:GUO
Middle Name:
Last Name:NIE
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 1:5615 7TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3509
Mailing Address - Country:US
Mailing Address - Phone:718-708-9611
Mailing Address - Fax:718-871-2516
Practice Address - Street 1:5615 7TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3509
Practice Address - Country:US
Practice Address - Phone:718-708-9611
Practice Address - Fax:718-871-2516
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics