Healthcare Provider Details

I. General information

NPI: 1689339871
Provider Name (Legal Business Name): JUSTIN ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JUSTIN ZHU PA-C

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 07/01/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE
DANBURY CT
06810-6099
US

IV. Provider business mailing address

PO BOX 23687
NEW YORK NY
10087-3687
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7000
  • Fax:
Mailing address:
  • Phone: 860-322-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5517
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: