Basic Information
| Provider Information | |||||||||
| NPI: | 1891008363 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ZHAO | ||||||||
| FirstName: | AIYU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 LANSING STREET | ||||||||
| Address2: | AUBURN MEMORIAL MEDICAL SERVICES, PC | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670455 | ||||||||
| FaxNumber: | 3152531795 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 NELSON ST | ||||||||
| Address2: | SUITE #120 | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670390 | ||||||||
| FaxNumber: | 3152528837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2010 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 275387 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 275387 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.