Provider Demographics
NPI:1679581086
Name:XU, JING (MD)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:XU
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 1:160 MOORLAND DR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1956
Mailing Address - Country:US
Mailing Address - Phone:914-725-6397
Mailing Address - Fax:
Practice Address - Street 1:260 GARTH RD
Practice Address - Street 2:SUITE 2H5
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4051
Practice Address - Country:US
Practice Address - Phone:914-725-6397
Practice Address - Fax:914-725-6397
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2230172084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02460777Medicaid
NY329BB1Medicare ID - Type Unspecified