Provider Demographics
NPI:1962422972
Name:HE, XIAORONG (MD)
Entity type:Individual
Prefix:
First Name:XIAORONG
Middle Name:
Last Name:HE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 JUSTICE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4556
Mailing Address - Country:US
Mailing Address - Phone:718-699-5283
Mailing Address - Fax:718-699-5293
Practice Address - Street 1:8701 JUSTICE AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4556
Practice Address - Country:US
Practice Address - Phone:718-699-5283
Practice Address - Fax:718-699-5293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01723179Medicaid
NYG16613Medicare UPIN
NY03120GMedicare PIN