Healthcare Provider Details

I. General information

NPI: 1114048642
Provider Name (Legal Business Name): ANGIE E WEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WORTH ST
NEW YORK NY
10013-3411
US

IV. Provider business mailing address

77 WORTH ST
NEW YORK NY
10013-3411
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-3901
  • Fax: 212-966-6295
Mailing address:
  • Phone: 212-966-3901
  • Fax: 212-966-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number243523
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number243523-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: