Provider Demographics
NPI:1992763916
Name:WU, QIONG (MD)
Entity type:Individual
Prefix:
First Name:QIONG
Middle Name:
Last Name:WU
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 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1212
Mailing Address - Country:US
Mailing Address - Phone:718-321-3522
Mailing Address - Fax:718-321-3533
Practice Address - Street 1:3808 UNION ST APT 3J
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-321-3522
Practice Address - Fax:718-321-3533
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine