Provider Demographics
NPI:1255438438
Name:ADVANCED PODIATRY AND WOUND CARE, PC.
Entity type:Organization
Organization Name:ADVANCED PODIATRY AND WOUND CARE, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-920-9122
Mailing Address - Street 1:492 N BROADWAY
Mailing Address - Street 2:#9
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3238
Mailing Address - Country:US
Mailing Address - Phone:718-920-9122
Mailing Address - Fax:718-920-6835
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:RM 101
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-518-9304
Practice Address - Fax:718-518-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005547213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377219Medicaid
NYPB0541Medicare ID - Type Unspecified
NY02377219Medicaid