Provider Demographics
NPI:1235795659
Name:TAN LI ZHE, RICHARD LI ZHE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LI ZHE
Last Name:TAN LI ZHE
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 1:475 SEAVIEW AVENUE STATEN ISLAND UNIVERSITY HOSPITAL,
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-226-8630
Mailing Address - Fax:
Practice Address - Street 1:475 SEAVIEW AVENUE, STATEN ISLAND UNIVERSITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2020-01-16
Deactivation Date:2019-12-20
Deactivation Code:
Reactivation Date:2020-01-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program