Healthcare Provider Details

I. General information

NPI: 1023253200
Provider Name (Legal Business Name): YOUSONG WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DALE RD STE 203
AVON CT
06001-3692
US

IV. Provider business mailing address

40 DALE RD STE 203
AVON CT
06001-3692
US

V. Phone/Fax

Practice location:
  • Phone: 631-974-8826
  • Fax: 860-325-6508
Mailing address:
  • Phone: 860-325-6908
  • Fax: 860-325-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number049426
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number049426
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number049426
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: