Healthcare Provider Details

I. General information

NPI: 1164541793
Provider Name (Legal Business Name): WEIGUO ZHANG L.AC, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JERSEY AVE UNIT 2
EAST SETAUKET NY
11733-2035
US

IV. Provider business mailing address

100 S JERSEY AVE UNIT 2
EAST SETAUKET NY
11733-2035
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-3232
  • Fax:
Mailing address:
  • Phone: 631-941-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: