Healthcare Provider Details

I. General information

NPI: 1154664803
Provider Name (Legal Business Name): LINDA WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 102ND ST
NEW YORK NY
10029-5204
US

IV. Provider business mailing address

150 E 42ND ST FL 9
NEW YORK NY
10017-5699
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8551
  • Fax: 212-831-8116
Mailing address:
  • Phone: 646-605-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number284463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number284463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: