Provider Demographics
NPI:1215628698
Name:QIU, YI
Entity type:Individual
Prefix:
First Name:YI
Middle Name:
Last Name:QIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7736 169TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1372
Mailing Address - Country:US
Mailing Address - Phone:917-660-9551
Mailing Address - Fax:
Practice Address - Street 1:10450 102ND ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2237
Practice Address - Country:US
Practice Address - Phone:929-354-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician