Healthcare Provider Details

I. General information

NPI: 1548976152
Provider Name (Legal Business Name): ZHANG FAJUN ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10802 OTIS AVE
CORONA NY
11368-3914
US

IV. Provider business mailing address

9906 58TH AVE APT 1A
CORONA NY
11368-3701
US

V. Phone/Fax

Practice location:
  • Phone: 929-218-9132
  • Fax:
Mailing address:
  • Phone: 929-218-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAJUN ZHANG
Title or Position: PRESIDENT
Credential: SOCIAL DAY CARE
Phone: 929-218-9132