Provider Demographics
NPI:1972576338
Name:GUO, JING (AUD)
Entity Type:Individual
Prefix:DR
First Name:JING
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GRAND ST STE 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4396
Mailing Address - Country:US
Mailing Address - Phone:347-393-3130
Mailing Address - Fax:718-259-1786
Practice Address - Street 1:217 GRAND ST STE 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4396
Practice Address - Country:US
Practice Address - Phone:347-393-3130
Practice Address - Fax:718-259-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001198-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02203501Medicaid
NY02203501Medicaid
NYM71941Medicare PIN
NY07020Medicare ID - Type UnspecifiedGHI MADICARE