Healthcare Provider Details

I. General information

NPI: 1972779080
Provider Name (Legal Business Name): HUICONG ZHAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 STONELEIGH AVE
CARMEL NY
10512-3940
US

IV. Provider business mailing address

PO BOX 4264
NEW WINDSOR NY
12553-0264
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5711
  • Fax:
Mailing address:
  • Phone: 845-565-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number245128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: