Healthcare Provider Details

I. General information

NPI: 1619672896
Provider Name (Legal Business Name): HEATHER WEN JAO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S BROADWAY STE 210
YONKERS NY
10705-6202
US

IV. Provider business mailing address

503 S BROADWAY STE 210
YONKERS NY
10705-6202
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-9771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number345346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: