Healthcare Provider Details

I. General information

NPI: 1386101087
Provider Name (Legal Business Name): MR. SHING ZHAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5932 163RD ST
FRESH MEADOWS NY
11365-1441
US

IV. Provider business mailing address

5932 163RD ST
FRESH MEADOWS NY
11365-1441
US

V. Phone/Fax

Practice location:
  • Phone: 646-591-5999
  • Fax:
Mailing address:
  • Phone: 646-591-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054809
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00417001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: