Provider Demographics
NPI:1376604611
Name:ZONG, OLIVER (DPM)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:ZONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 LORRAINE CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5112
Mailing Address - Country:US
Mailing Address - Phone:347-668-9567
Mailing Address - Fax:
Practice Address - Street 1:80 MAIDEN LN
Practice Address - Street 2:SUITE 703
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4811
Practice Address - Country:US
Practice Address - Phone:212-385-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005618-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPH2041Medicare ID - Type Unspecified
NYU92572Medicare UPIN