Provider Demographics
NPI:1801974142
Name:QIU, JIN (MD)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:QIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANN JIN
Other - Middle Name:
Other - Last Name:QIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:141 E 55TH ST
Mailing Address - Street 2:SUITE # 10A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4034
Mailing Address - Country:US
Mailing Address - Phone:212-758-8851
Mailing Address - Fax:347-527-9166
Practice Address - Street 1:141 E 55TH ST STE 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4050
Practice Address - Country:US
Practice Address - Phone:212-758-8851
Practice Address - Fax:347-527-9166
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08299200207Q00000X
NYNY198620208D00000X
NY198620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134098707OtherTAX ID
NY198620OtherNYS
NJ25MA08299200OtherNJ PRACTICE LOCATION
NJ25MA08299200OtherNJ PRACTICE LOCATION
NY198620OtherNYS