Healthcare Provider Details

I. General information

NPI: 1013089457
Provider Name (Legal Business Name): LI ZHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 BELLEVILLE TPKE
KEARNY NJ
07032-3203
US

IV. Provider business mailing address

232 BELLEVILLE TPKE
KEARNY NJ
07032-3203
US

V. Phone/Fax

Practice location:
  • Phone: 201-998-3020
  • Fax: 201-998-0021
Mailing address:
  • Phone: 201-998-3020
  • Fax: 201-998-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07574100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0030449
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: