Healthcare Provider Details

I. General information

NPI: 1003409731
Provider Name (Legal Business Name): WOON YEE WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 12/25/2021
Certification Date: 12/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 FIRST AVENUE HCC SUITE 4H
NEW YORK NY
10016
US

IV. Provider business mailing address

10521 89TH ST
OZONE PARK NY
11417-1339
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-0568
  • Fax:
Mailing address:
  • Phone: 646-229-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346575
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: