Healthcare Provider Details

I. General information

NPI: 1568132561
Provider Name (Legal Business Name): WENDY RUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 11/08/2023
Certification Date: 09/20/2021
Deactivation Date: 10/04/2023
Reactivation Date: 11/08/2023

III. Provider practice location address

184 ELDRIDGE ST
NEW YORK NY
10002-2924
US

IV. Provider business mailing address

184 ELDRIDGE ST
NEW YORK NY
10002-2992
US

V. Phone/Fax

Practice location:
  • Phone: 347-725-0830
  • Fax:
Mailing address:
  • Phone: 347-725-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: