Healthcare Provider Details

I. General information

NPI: 1144133448
Provider Name (Legal Business Name): DA WU MEDICAL PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8716 QUEENS BLVD
ELMHURST NY
11373-4419
US

IV. Provider business mailing address

324 AVALON GARDENS DR
NANUET NY
10954-7414
US

V. Phone/Fax

Practice location:
  • Phone: 617-669-8422
  • Fax:
Mailing address:
  • Phone: 617-669-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DA WU
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 617-669-8422