Healthcare Provider Details

I. General information

NPI: 1447297924
Provider Name (Legal Business Name): LIJUN WENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1379 54TH ST SUITE 3
BROOKLYN NY
11219
US

IV. Provider business mailing address

20915 50TH AVE
OAKLAND GARDENS NY
11364-1128
US

V. Phone/Fax

Practice location:
  • Phone: 718-633-4075
  • Fax: 718-633-4006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number232264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: