Individual
JACK QIU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4870
(215) 955-6161
Mailing address
111 S 11TH ST STE 8280, PHILADELPHIA, PA 19107-4870
(215) 955-6161
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA12823800
NJ
207L00000X
Anesthesiology Physician
MD490765
PA
Other
Enumeration date
05/26/2020
Last updated
09/25/2025
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