Provider Demographics
NPI:1265978365
Name:JIN QIU MD PC
Entity type:Organization
Organization Name:JIN QIU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-201-0268
Mailing Address - Street 1:141 E 55TH ST APT 4C
Mailing Address - Street 2:APT 4C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4050
Mailing Address - Country:US
Mailing Address - Phone:646-201-0268
Mailing Address - Fax:347-527-9166
Practice Address - Street 1:141 E 55TH ST APT 4C
Practice Address - Street 2:APT 4C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4050
Practice Address - Country:US
Practice Address - Phone:646-201-0268
Practice Address - Fax:347-527-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY198620261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY198620OtherNYS
NJ25MA08299200OtherNJ PRACTICE LOCATION
0D1531Medicare PIN
NJ25MA08299200OtherNJ PRACTICE LOCATION