Provider Demographics
NPI:1306882444
Name:ZHANG, JIAN (DPM)
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-1641
Mailing Address - Country:US
Mailing Address - Phone:718-655-3410
Mailing Address - Fax:718-655-3475
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:MEDUCAL VILLAGE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-518-9304
Practice Address - Fax:718-518-9401
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005547213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377219Medicaid
NYPB0541Medicare ID - Type Unspecified
NY02377219Medicaid