Healthcare Provider Details

I. General information

NPI: 1235886151
Provider Name (Legal Business Name): XUERONG WU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

2633 28TH ST APT 2B
ASTORIA NY
11102-4817
US

V. Phone/Fax

Practice location:
  • Phone: 646-578-3939
  • Fax:
Mailing address:
  • Phone: 646-578-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: