=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982091419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENJING ZHAO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2015
-----------------------------------------------------
Last Update Date | 04/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 746 AUSTIN ST
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07090-4446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-208-7409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 746 AUSTIN ST
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07090-4446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-208-7409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00111800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 004757
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------