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General NPI Number Information
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NPI Number | 1265749550
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Entity Type | Individual
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Provider Name | JINGBO ZHAO M.D
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Gender | Male
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 4316 215TH ST APT 1
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City | BAYSIDE
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State | NY
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Zip | 11361-2976
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Country | US
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Telephone | 718-224-0120
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Fax | 718-224-0130
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Provider Business Mailing Address
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Address Line | 3275 HARBOR POINT RD
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City | BALDWIN
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State | NY
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Zip | 11510-5140
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Country | US
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Telephone | 212-379-6996
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Fax | 212-379-6929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 257808
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License Number State | NY
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