Provider Demographics
NPI:1164634432
Name:JIANSHENG ZHAO MEDICAL PC
Entity Type:Organization
Organization Name:JIANSHENG ZHAO MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIANSHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-939-3780
Mailing Address - Street 1:3907 PRINCE ST
Mailing Address - Street 2:SUITE 4F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5399
Mailing Address - Country:US
Mailing Address - Phone:718-939-3780
Mailing Address - Fax:718-939-7040
Practice Address - Street 1:39-07 PRINCE STREET
Practice Address - Street 2:SUITE 4F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5399
Practice Address - Country:US
Practice Address - Phone:718-939-3780
Practice Address - Fax:718-939-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY203543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01694848Medicaid
NY02508AMedicare PIN