Healthcare Provider Details

I. General information

NPI: 1376960831
Provider Name (Legal Business Name): WING SZE LEUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2014
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 VANDERBILT AVENUE
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

165 VANDERBILT AVENUE
STATEN ISLAND NY
10304
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-0965
  • Fax:
Mailing address:
  • Phone: 718-616-0965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number287563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: