Healthcare Provider Details

I. General information

NPI: 1750319190
Provider Name (Legal Business Name): MAUNG TINT WAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROME AVE
STATEN ISLAND NY
10304-4318
US

IV. Provider business mailing address

5616 6TH AVE
BROOKLYN NY
11220-3419
US

V. Phone/Fax

Practice location:
  • Phone: 718-989-9283
  • Fax: 718-989-9282
Mailing address:
  • Phone: 718-439-5440
  • Fax: 718-492-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number238056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: