Healthcare Provider Details

I. General information

NPI: 1619267655
Provider Name (Legal Business Name): PENGFEI WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE 5TH FLOOR ADMIN - OB-GYN DEPT
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-8383
  • Fax: 718-239-8360
Mailing address:
  • Phone: 718-239-8383
  • Fax: 718-239-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number69250-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number287233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: