Healthcare Provider Details

I. General information

NPI: 1750624334
Provider Name (Legal Business Name): TIAN CHENG ZHOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK DR STE 10
WEST NYACK NY
10994-1966
US

IV. Provider business mailing address

2 MEDICAL PARK DR STE 10
WEST NYACK NY
10994-1966
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-5000
  • Fax: 845-354-9469
Mailing address:
  • Phone: 845-354-5000
  • Fax: 845-354-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number297105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: