Healthcare Provider Details

I. General information

NPI: 1154758852
Provider Name (Legal Business Name): EVERGREEN BORO PARK COMPREHENSIVE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5724 7TH AVENUE 2ND FLOOR
BROOKLYN NY
11220
US

IV. Provider business mailing address

PO BOX 270
MASSAPEQUA PARK NY
11762-0270
US

V. Phone/Fax

Practice location:
  • Phone: 347-782-1732
  • Fax:
Mailing address:
  • Phone: 631-264-2035
  • Fax: 631-264-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number234019
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUMEI ZHOU
Title or Position: OWNER
Credential: M.D.
Phone: 646-492-2500