Healthcare Provider Details

I. General information

NPI: 1629333018
Provider Name (Legal Business Name): JING GRACE WANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 COMMERCE ST
YORKTOWN HEIGHTS NY
10598-4428
US

IV. Provider business mailing address

1940 COMMERCE ST
YORKTOWN HEIGHTS NY
10598-4428
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-5506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00283075
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOT014547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: