Basic Information
| Provider Information | |||||||||
| NPI: | 1447856935 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | XU | ||||||||
| FirstName: | YINGXIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4310 CRESCENT ST APT 3903 | ||||||||
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| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111014297 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4308 52ND ST FL 2 | ||||||||
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| City: | WOODSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113774542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184584243 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2020 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | P113105 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist |
No ID Information.