Provider Demographics
NPI:1902227838
Name:ZHANG, SELENA
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:XIAOJUAN
Other - Middle Name:
Other - Last Name:LIAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24040 70TH AVE UNIT 17C
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1948
Mailing Address - Country:US
Mailing Address - Phone:347-730-8723
Mailing Address - Fax:
Practice Address - Street 1:24040 70TH AVE UNIT 17C
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1948
Practice Address - Country:US
Practice Address - Phone:347-730-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY788537131390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program