Healthcare Provider Details

I. General information

NPI: 1568735512
Provider Name (Legal Business Name): JYMING WANG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13336 41ST RD SUITE 2M
FLUSHING NY
11355-3666
US

IV. Provider business mailing address

13336 41ST RD SUITE 2M
FLUSHING NY
11355-3666
US

V. Phone/Fax

Practice location:
  • Phone: 718-463-0093
  • Fax: 718-463-0486
Mailing address:
  • Phone: 718-463-0093
  • Fax: 718-463-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNY 204617
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberNY 134348
License Number StateNY

VIII. Authorized Official

Name: DR. JYMING WANG
Title or Position: OWNER
Credential: M.D.
Phone: 718-463-0093