Healthcare Provider Details

I. General information

NPI: 1124936505
Provider Name (Legal Business Name): MR. TIGER ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

IV. Provider business mailing address

3925 61ST ST UNIT 770217
WOODSIDE NY
11377-8710
US

V. Phone/Fax

Practice location:
  • Phone: 908-588-3635
  • Fax:
Mailing address:
  • Phone: 347-352-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: