Healthcare Provider Details

I. General information

NPI: 1871850503
Provider Name (Legal Business Name): GUOBIN WANG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5847 188TH ST
FRESH MEADOWS NY
11365-2201
US

IV. Provider business mailing address

6 LOWELL AVE
NEW HYDE PARK NY
11040-2810
US

V. Phone/Fax

Practice location:
  • Phone: 718-357-8200
  • Fax: 718-357-5770
Mailing address:
  • Phone: 516-326-4160
  • Fax: 516-354-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014501
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: