Healthcare Provider Details

I. General information

NPI: 1548841661
Provider Name (Legal Business Name): JACK RUICONG ZHONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RUICONG ZHONG

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

100 HAVEN AVE APT 26D
NEW YORK NY
10032-2627
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5506
  • Fax:
Mailing address:
  • Phone: 336-391-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13-3971298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: