Healthcare Provider Details

I. General information

NPI: 1134372303
Provider Name (Legal Business Name): BRONX FOOT REHABILITATION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 E 204TH ST
BRONX NY
10467-4602
US

IV. Provider business mailing address

326 E 204TH ST
BRONX NY
10467-4602
US

V. Phone/Fax

Practice location:
  • Phone: 718-655-3410
  • Fax: 718-655-3475
Mailing address:
  • Phone: 718-655-3410
  • Fax: 718-655-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005547
License Number StateNY

VIII. Authorized Official

Name: JIAN ZHANG
Title or Position: VICE PRESIDENT
Credential: DPM
Phone: 718-655-3410