Provider Demographics
NPI:1750565792
Name:WEIMIN QU MD PC
Entity type:Organization
Organization Name:WEIMIN QU MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WEIMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:QU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-0021
Mailing Address - Street 1:142-10B ROOSEVELT AVENUE
Mailing Address - Street 2:#24
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-888-0021
Mailing Address - Fax:718-888-7869
Practice Address - Street 1:142-10B ROOSEVELT AVENUE
Practice Address - Street 2:#24
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-888-0021
Practice Address - Fax:718-888-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02334458Medicaid