Provider Demographics
NPI:1174829642
Name:XIAOYUAN ZHAO PHYSICIAN PLLC
Entity Type:Organization
Organization Name:XIAOYUAN ZHAO PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOYUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-966-8454
Mailing Address - Street 1:80 BOWERY RM 401
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4664
Mailing Address - Country:US
Mailing Address - Phone:212-966-8454
Mailing Address - Fax:212-966-1846
Practice Address - Street 1:80 BOWERY RM 401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4664
Practice Address - Country:US
Practice Address - Phone:212-966-8454
Practice Address - Fax:212-966-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty