Healthcare Provider Details

I. General information

NPI: 1275639502
Provider Name (Legal Business Name): MR. BENJAMIN WU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 60TH ST FL 1
BROOKLYN NY
11220-4220
US

IV. Provider business mailing address

730 60TH ST FL 1
BROOKLYN NY
11220-4220
US

V. Phone/Fax

Practice location:
  • Phone: 718-484-3225
  • Fax:
Mailing address:
  • Phone: 718-484-3225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number217687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: