Healthcare Provider Details

I. General information

NPI: 1275591729
Provider Name (Legal Business Name): ZHICHENG LU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 NORTHERN BLVD STE 106
GREAT NECK NY
11021-4717
US

IV. Provider business mailing address

25 GENEVIEVE PL
GREAT NECK NY
11021-4347
US

V. Phone/Fax

Practice location:
  • Phone: 917-579-6886
  • Fax: 516-487-3880
Mailing address:
  • Phone: 917-579-6886
  • Fax: 516-487-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number233928
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number233928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: