Provider Demographics
NPI:1679570246
Name:ZHANG, JIAN WEI (MD)
Entity type:Individual
Prefix:MR
First Name:JIAN WEI
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST STE 709
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4557
Mailing Address - Country:US
Mailing Address - Phone:212-965-0496
Mailing Address - Fax:212-965-0425
Practice Address - Street 1:139 CENTRE ST STE 709
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4557
Practice Address - Country:US
Practice Address - Phone:212-965-0496
Practice Address - Fax:212-965-0425
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2019-02-27
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NY207542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01818157Medicaid
NY01818157Medicaid
NY01818157Medicaid