Provider Demographics
NPI:1013998962
Name:GAO, XINGONG (LAC PT DPT)
Entity type:Individual
Prefix:
First Name:XINGONG
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:LAC PT DPT
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:XINGONG
Other - Last Name:GAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY
Mailing Address - Street 2:STE 709
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3018
Mailing Address - Country:US
Mailing Address - Phone:212-625-9290
Mailing Address - Fax:212-925-3101
Practice Address - Street 1:401 BROADWAY
Practice Address - Street 2:STE 709
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3018
Practice Address - Country:US
Practice Address - Phone:212-625-9290
Practice Address - Fax:212-925-3101
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002222 1171100000X
NY013918 1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23041Medicare ID - Type Unspecified