Healthcare Provider Details

I. General information

NPI: 1023047990
Provider Name (Legal Business Name): TRACEY ZHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 CHAPEL ST NEW HAVEN MEDICAL SPORTS & OCCUPATIONAL HEALTH
NEW HAVEN CT
06511
US

IV. Provider business mailing address

PO BOX 509
NORWALK CT
06852-0509
US

V. Phone/Fax

Practice location:
  • Phone: 203-776-3375
  • Fax: 203-776-3171
Mailing address:
  • Phone: 203-847-5351
  • Fax: 203-847-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number038469
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: