Provider Demographics
NPI:1881600823
Name:ZHANG, YUANXIA (PHD)
Entity type:Individual
Prefix:DR
First Name:YUANXIA
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 ROBINSON ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3193
Mailing Address - Country:US
Mailing Address - Phone:718-666-7176
Mailing Address - Fax:718-358-7442
Practice Address - Street 1:4318 ROBINSON ST
Practice Address - Street 2:STE 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3193
Practice Address - Country:US
Practice Address - Phone:212-238-8103
Practice Address - Fax:212-238-7760
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015344-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357793Medicaid
NY0132SGMedicare ID - Type UnspecifiedGHI MEDICARE #
NY02357793Medicaid