=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003035494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUI WANG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 09/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 MEDICAL CENTER DR SUITE 209
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13066-6631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-329-7666
-----------------------------------------------------
Fax | 315-632-4597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 PLAZA DR SUITE B
-----------------------------------------------------
City | VESTAL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13850-3640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-798-7680
-----------------------------------------------------
Fax | 607-238-7713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 001723
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 001723-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------