Healthcare Provider Details

I. General information

NPI: 1932802964
Provider Name (Legal Business Name): ELIZABETH WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

HSC T-18 - 089
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

HSC T-18 - 089
STONY BROOK NY
11794-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1487
  • Fax: 631-444-3502
Mailing address:
  • Phone: 631-444-1487
  • Fax: 631-444-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: