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General NPI Number Information
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NPI Number | 1154758852
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Entity Type | Organization
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Legal Business Name | EVERGREEN BORO PARK COMPREHENSIVE MEDICINE PLLC
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 5724 7TH AVENUE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11220
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Country | US
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Telephone | 347-782-1732
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 270
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-0270
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Country | US
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Telephone | 631-264-2035
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Fax | 631-264-1418
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Authorized Official
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Title or Position | OWNER
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Name | SUMEI ZHOU
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Credential | M.D.
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Telephone | 646-492-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 234019
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License Number State | NY
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