Healthcare Provider Details

I. General information

NPI: 1215824214
Provider Name (Legal Business Name): WANHUA ZHONG REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22215 NORTHERN BLVD # 11361
BAYSIDE NY
11361-3678
US

IV. Provider business mailing address

10757 106TH ST
OZONE PARK NY
11417-2332
US

V. Phone/Fax

Practice location:
  • Phone: 917-330-8212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number929263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: