Healthcare Provider Details

I. General information

NPI: 1982903704
Provider Name (Legal Business Name): AITAO ZHANG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 9TH INFANTRY ST BOX 694
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

13537 37TH AVE APT 3D
FLUSHING NY
11354-6601
US

V. Phone/Fax

Practice location:
  • Phone: 646-853-3391
  • Fax:
Mailing address:
  • Phone: 646-853-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25003696
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number10296755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: