Healthcare Provider Details

I. General information

NPI: 1427634013
Provider Name (Legal Business Name): XIAYUN ZHUGE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015B SANFORD AVE # 2FL
FLUSHING NY
11355-2557
US

IV. Provider business mailing address

14015B SANFORD AVE # 2FL
FLUSHING NY
11355-2557
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-8288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109151-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: