Provider Demographics
NPI:1831142843
Name:GU, XI FREDA (MD)
Entity type:Individual
Prefix:DR
First Name:XI
Middle Name:FREDA
Last Name:GU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ELIZABETH ST
Mailing Address - Street 2:RM. 301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4803
Mailing Address - Country:US
Mailing Address - Phone:212-274-1705
Mailing Address - Fax:212-274-1936
Practice Address - Street 1:15 ELIZABETH ST
Practice Address - Street 2:RM. 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-274-1705
Practice Address - Fax:212-274-1936
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01673569Medicaid
NYG33463Medicare UPIN
NY01673569Medicaid