Healthcare Provider Details

I. General information

NPI: 1124624085
Provider Name (Legal Business Name): MR. WEI ZHOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24610 61ST AVE
LITTLE NECK NY
11362-2020
US

IV. Provider business mailing address

24610 61ST AVE
LITTLE NECK NY
11362-2020
US

V. Phone/Fax

Practice location:
  • Phone: 516-417-0860
  • Fax:
Mailing address:
  • Phone: 516-417-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number028551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: