Provider Demographics
NPI:1265749550
Name:ZHAO, JINGBO (MD)
Entity type:Individual
Prefix:
First Name:JINGBO
Middle Name:
Last Name:ZHAO
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 1:3275 HARBOR POINT RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5140
Mailing Address - Country:US
Mailing Address - Phone:212-379-6996
Mailing Address - Fax:212-379-6929
Practice Address - Street 1:4316 215TH ST APT 1
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2976
Practice Address - Country:US
Practice Address - Phone:718-224-0120
Practice Address - Fax:718-224-0130
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03338103Medicaid
NY60257808OtherNYSED