Healthcare Provider Details

I. General information

NPI: 1003710856
Provider Name (Legal Business Name): WANG PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 71ST RD STE 102
FOREST HILLS NY
11375-4905
US

IV. Provider business mailing address

11020 71ST RD STE 102
FOREST HILLS NY
11375-4905
US

V. Phone/Fax

Practice location:
  • Phone: 646-580-0686
  • Fax: 917-475-2562
Mailing address:
  • Phone: 646-580-0686
  • Fax: 917-475-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRIS WANG
Title or Position: PRESIDENT
Credential: MD
Phone: 646-580-0686