=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922136753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRONX FOOT REHABILITATION ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 11/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3112 WEBSTER AVE GROUND FLOOR
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-655-3410
-----------------------------------------------------
Fax | 718-655-3475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3112 WEBSTER AVE GROUND FLOOR
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-655-3410
-----------------------------------------------------
Fax | 718-655-3475
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JIAN ZHANG
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 718-655-3410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------