Healthcare Provider Details

I. General information

NPI: 1114842119
Provider Name (Legal Business Name): XINWAN ZHANG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 GRAND CONCOURSE
BRONX NY
10458-5203
US

IV. Provider business mailing address

2488 GRAND CONCOURSE
BRONX NY
10458-5203
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-7600
  • Fax:
Mailing address:
  • Phone: 718-881-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP145202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: