Healthcare Provider Details

I. General information

NPI: 1982984019
Provider Name (Legal Business Name): NOVA MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2011
Last Update Date: 08/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16331 26TH AVE
FLUSHING NY
11358-1009
US

IV. Provider business mailing address

16331 26TH AVE
FLUSHING NY
11358-1009
US

V. Phone/Fax

Practice location:
  • Phone: 917-650-5017
  • Fax:
Mailing address:
  • Phone: 917-650-5017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number237658
License Number StateNY

VIII. Authorized Official

Name: DIANA ZHENG
Title or Position: PRINCIPAL
Credential: M.D.
Phone: 917-650-5017