Provider Demographics
NPI:1730574583
Name:ZHAO, SUSAN (DPM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST STE 702
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4557
Mailing Address - Country:US
Mailing Address - Phone:646-266-7963
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST STE 702
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4557
Practice Address - Country:US
Practice Address - Phone:212-226-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSN006939-1213ES0103X
NYN006939-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery