Provider Demographics
NPI: | 1750456737 |
---|---|
Name: | ZWANG, JEFFREY S (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JEFFREY |
Middle Name: | S |
Last Name: | ZWANG |
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: | 370 E MAIN ST |
Mailing Address - Street 2: | SUITE 5 |
Mailing Address - City: | BAY SHORE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11706-8415 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 631-666-5864 |
Mailing Address - Fax: | 631-666-1187 |
Practice Address - Street 1: | 370 EAST MAIN STREET |
Practice Address - Street 2: | SUITE 5 |
Practice Address - City: | BAY SHORE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11706 |
Practice Address - Country: | US |
Practice Address - Phone: | 631-666-5864 |
Practice Address - Fax: | 631-666-1187 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-11-22 |
Last Update Date: | 2011-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 144257 | 207RC0200X, 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 00902209 | Medicaid | |
B14927 | Medicare UPIN | ||
NY | 00902209 | Medicaid |