Basic Information
Provider Information
NPI: 1134362171
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZHAO
FirstName: DONGMEI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 30 PROSPECT AVE
Address2:  
City: HACKENSACK
State: NJ
PostalCode: 076011915
CountryCode: US
TelephoneNumber: 5519964731
FaxNumber: 5519963298
Practice Location
Address1: 30 PROSPECT AVE
Address2:  
City: HACKENSACK
State: NJ
PostalCode: 076011915
CountryCode: US
TelephoneNumber: 5519964731
FaxNumber: 5519963298
Other Information
ProviderEnumerationDate: 04/07/2009
LastUpdateDate: 04/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X25MA10712600NJY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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