MEDICARE: SKYVIEW COMPREHENSIVE MEDICAL CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	254457	NY
2	208000000X	Pediatrics Physician	261824	NY
3	208000000X	Pediatrics Physician	275114	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538614508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYVIEW COMPREHENSIVE MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	13107 40TH RD
Second Line	:	E09
City	:	FLUSHING
State	:	NY
Zip	:	11354-5116
Country	:	US
Telephone Number	:	718-886-4068
Fax Number	:

Provider Business Practice Location Address
First Line	:	13107 40TH RD
Second Line	:	E09
City	:	FLUSHING
State	:	NY
Zip	:	11354-5116
Country	:	US
Telephone Number	:	718-886-4068
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ZHIYOU ZHANG
Credential	:	M.D.
Telephone Number	:	717-877-2268

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	11/11/2016

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