Healthcare Provider Details

I. General information

NPI: 1376148148
Provider Name (Legal Business Name): WENXIAO ZHOU MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

401 E 89TH ST APT 9F
NEW YORK NY
10128-7013
US

V. Phone/Fax

Practice location:
  • Phone: 646-309-6958
  • Fax:
Mailing address:
  • Phone: 646-309-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberP105163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: