Provider Demographics
NPI:1548841661
Name:ZHONG, JACK RUICONG (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:RUICONG
Last Name:ZHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RUICONG
Other - Middle Name:
Other - Last Name:ZHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 HAVEN AVE APT 26D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2627
Mailing Address - Country:US
Mailing Address - Phone:336-391-0042
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13-3971298390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program