Healthcare Provider Details

I. General information

NPI: 1619775970
Provider Name (Legal Business Name): HAIYUE ZHONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 175TH ST
FRESH MEADOWS NY
11365-3414
US

IV. Provider business mailing address

6929 175TH ST
FRESH MEADOWS NY
11365-3414
US

V. Phone/Fax

Practice location:
  • Phone: 646-897-0333
  • Fax:
Mailing address:
  • Phone: 646-897-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: