Provider Demographics
NPI:1003868399
Name:ZHANG, XUESHU (MD)
Entity Type:Individual
Prefix:
First Name:XUESHU
Middle Name:
Last Name:ZHANG
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 1:133-47 SANFORD AVENUE
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-359-5780
Mailing Address - Fax:718-359-5821
Practice Address - Street 1:133-47 SANFORD AVENUE
Practice Address - Street 2:SUITE 1F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-359-5780
Practice Address - Fax:718-359-5821
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02087130Medicaid
NY04976Medicare ID - Type Unspecified
NYH21231Medicare UPIN
NY63B261Medicare ID - Type Unspecified