MEDICARE: DR. IWEN WU PSY. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	1764230	NY

General Provider Information

NPI Number	:	1467704833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IWEN WU PSY. D

Provider Business Mailing Address
First Line	:	5335 212TH ST
Second Line	:
City	:	BAYSIDE HILLS
State	:	NY
Zip	:	11364-1811
Country	:	US
Telephone Number	:	718-352-0104
Fax Number	:	718-352-0131

Provider Business Practice Location Address
First Line	:	5335 212TH ST
Second Line	:
City	:	BAYSIDE HILLS
State	:	NY
Zip	:	11364-1811
Country	:	US
Telephone Number	:	718-352-0104
Fax Number	:	718-352-0131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	10/10/2012

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