Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA07574100 | NJ |
NPI | 1013089457 |
---|---|
Provider Name | Li Zhang |
First Address | Kearny, NJ 07032-3545 |
Second Address | Kearny, NJ 07032-3545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H83758 | (02) | NJ |