Provider Demographics
NPI:1922193259
Name:QIAN, XINRU (MD)
Entity Type:Individual
Prefix:DR
First Name:XINRU
Middle Name:
Last Name:QIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:XINRUQ
Other - Middle Name:
Other - Last Name:QIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14037 CHERRY AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-7818
Mailing Address - Country:US
Mailing Address - Phone:718-661-4201
Mailing Address - Fax:718-661-0066
Practice Address - Street 1:14037 CHERRY AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-7818
Practice Address - Country:US
Practice Address - Phone:718-661-4201
Practice Address - Fax:718-661-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218615208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206715Medicaid
NY02206715Medicaid
2I0351Medicare ID - Type Unspecified