Provider Demographics
NPI:1811921711
Name:DAI, GUORONG (MD)
Entity type:Individual
Prefix:
First Name:GUORONG
Middle Name:
Last Name:DAI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4028 COLLEGE POINT BOULEVARD
Mailing Address - Street 2:PH 110
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-7997
Mailing Address - Country:US
Mailing Address - Phone:646-750-2090
Mailing Address - Fax:718-928-7438
Practice Address - Street 1:825 57TH STREET
Practice Address - Street 2:SUITE 208 2ND FLOOR REAR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3674
Practice Address - Country:US
Practice Address - Phone:646-750-2090
Practice Address - Fax:718-928-7438
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-05-28
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Provider Licenses
StateLicense IDTaxonomies
NY240459208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03185820Medicaid
NY02771204Medicaid