Healthcare Provider Details

I. General information

NPI: 1194484170
Provider Name (Legal Business Name): CHONG ZHAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 09/15/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WESTWOOD DR APT 172
WESTBURY NY
11590-1627
US

IV. Provider business mailing address

155 WESTWOOD DR APT 172
WESTBURY NY
11590-1627
US

V. Phone/Fax

Practice location:
  • Phone: 347-506-5816
  • Fax:
Mailing address:
  • Phone: 347-506-5816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007177
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031878
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: