Provider Demographics
NPI:1598379646
Name:ZHAO, FENG (MS, RDN, CDN)
Entity Type:Individual
Prefix:
First Name:FENG
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W 112TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3521
Mailing Address - Country:US
Mailing Address - Phone:917-804-6112
Mailing Address - Fax:
Practice Address - Street 1:218 W 112TH ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3521
Practice Address - Country:US
Practice Address - Phone:917-804-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86050620133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered