Healthcare Provider Details

I. General information

NPI: 1750776795
Provider Name (Legal Business Name): LUHAN DAPHNE WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 SOUTH ST
NEW YORK NY
10002-7827
US

IV. Provider business mailing address

253 SOUTH ST
NEW YORK NY
10002-7827
US

V. Phone/Fax

Practice location:
  • Phone: 646-740-1055
  • Fax:
Mailing address:
  • Phone: 646-740-1055
  • Fax: 212-732-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number289281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: