Provider Demographics
NPI:1427326065
Name:GAO, PEI (MD)
Entity type:Individual
Prefix:
First Name:PEI
Middle Name:
Last Name:GAO
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 1:3916 PRINCE ST STE 257
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5367
Mailing Address - Country:US
Mailing Address - Phone:718-353-4280
Mailing Address - Fax:718-353-1862
Practice Address - Street 1:3916 PRINCE ST STE 257
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5367
Practice Address - Country:US
Practice Address - Phone:718-353-4280
Practice Address - Fax:718-353-1862
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46-1256370Medicaid