Provider Demographics
NPI:1982903704
Name:ZHANG, AITAO (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AITAO
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13537 37TH AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6601
Mailing Address - Country:US
Mailing Address - Phone:646-853-3391
Mailing Address - Fax:
Practice Address - Street 1:3531 9TH INFANTRY ST BOX 694
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:646-853-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25003696171100000X
NY10296755164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No164W00000XNursing Service ProvidersLicensed Practical Nurse