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General NPI Number Information
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NPI Number | 1780051904
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Entity Type | Individual
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Provider Name | ZHENYU MAO MSW
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Gender | Male
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 111 LIVINGSTON ST
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City | BROOKLYN
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State | NY
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Zip | 11201-1260
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Country | US
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Telephone | 800-314-8078
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Fax |
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Provider Business Mailing Address
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Address Line | 513 81ST ST
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City | BROOKLYN
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State | NY
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Zip | 11209-4012
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Country | US
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Telephone | 718-877-9977
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 095589
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License Number State | NY
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