Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 257677 | NY |
NPI | 1053553701 |
---|---|
Provider Name | Su Zhan |
First Address | Williamsville, NY 14221-7470 |
Second Address | West Seneca, NY 14224-2646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2009 |
Last Update Date | 31/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03114023 | (05) | NY |