Healthcare Provider Details

I. General information

NPI: 1912320284
Provider Name (Legal Business Name): JC ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 BLOSSOM AVE
FLUSHING NY
11355-4639
US

IV. Provider business mailing address

13420 BLOSSOM AVE
FLUSHING NY
11355-4639
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-2567
  • Fax:
Mailing address:
  • Phone: 718-869-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number273276
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number273276
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number273276
License Number StateNY

VIII. Authorized Official

Name: JIANQING ZHANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-869-2567