Healthcare Provider Details

I. General information

NPI: 1295204998
Provider Name (Legal Business Name): RUOXIN WANG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 EAST AVE
HILTON NY
14468-1392
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-392-9100
  • Fax:
Mailing address:
  • Phone: 585-392-9100
  • Fax: 585-392-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: