Healthcare Provider Details

I. General information

NPI: 1689910523
Provider Name (Legal Business Name): CHUN-CHI WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 161ST ST
FLUSHING NY
11358-4121
US

IV. Provider business mailing address

4214 161ST ST
FLUSHING NY
11358-4121
US

V. Phone/Fax

Practice location:
  • Phone: 347-207-3805
  • Fax:
Mailing address:
  • Phone: 347-207-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number016899-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number016899-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: