Healthcare Provider Details

I. General information

NPI: 1639090699
Provider Name (Legal Business Name): MR. ANDY ZHAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 E 23RD ST
BROOKLYN NY
11235-2510
US

IV. Provider business mailing address

2417 E 23RD ST
BROOKLYN NY
11235-2510
US

V. Phone/Fax

Practice location:
  • Phone: 718-249-9621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: