Healthcare Provider Details

I. General information

NPI: 1366826786
Provider Name (Legal Business Name): VINCENT WANG WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 PRINCE ST STE 251
FLUSHING NY
11354-5361
US

IV. Provider business mailing address

39-16 PRINCE STREET STE 251
FLUSHING NY
11354
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-3877
  • Fax: 718-886-3995
Mailing address:
  • Phone: 718-886-3877
  • Fax: 718-886-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339834
License Number StateNY

VIII. Authorized Official

Name: VINCENT WANG
Title or Position: MD
Credential: D.O.
Phone: 718-886-3877