Healthcare Provider Details

I. General information

NPI: 1033573365
Provider Name (Legal Business Name): HAN ZHONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

PO BOX 412826
BOSTON MA
02241-2526
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-2065
  • Fax: 908-522-5763
Mailing address:
  • Phone: 610-892-8889
  • Fax: 484-446-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11386600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: