Healthcare Provider Details

I. General information

NPI: 1528921244
Provider Name (Legal Business Name): ZIXI ZHAO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6304 5TH AVE
BROOKLYN NY
11220-5284
US

IV. Provider business mailing address

7 NAVY PIER CT UNIT 2071
STATEN ISLAND NY
10304-5419
US

V. Phone/Fax

Practice location:
  • Phone: 718-576-3610
  • Fax:
Mailing address:
  • Phone: 614-849-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP134503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: