Healthcare Provider Details

I. General information

NPI: 1659335941
Provider Name (Legal Business Name): HERRICK WUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WILLIAM ST FL 12
NEW YORK NY
10038-5322
US

IV. Provider business mailing address

170 WILLIAM ST FL 5
NEW YORK NY
10038-2612
US

V. Phone/Fax

Practice location:
  • Phone: 212-312-5577
  • Fax: 212-312-5769
Mailing address:
  • Phone: 212-312-5577
  • Fax: 212-312-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number214251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: