Healthcare Provider Details

I. General information

NPI: 1619288065
Provider Name (Legal Business Name): ELLEN WANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 39TH AVE FL 2
FLUSHING NY
11354-5598
US

IV. Provider business mailing address

13656 39TH AVE FL 2
FLUSHING NY
11354-5598
US

V. Phone/Fax

Practice location:
  • Phone: 212-335-0328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MB09209200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number282507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: