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General NPI Number Information
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NPI Number | 1114188182
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Entity Type | Individual
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Provider Name | ANDREA S. WANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2008
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 2315 BROADWAY 3RD FL
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City | NEW YORK
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State | NY
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Zip | 10024-4332
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Country | US
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Telephone | 646-962-3681
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Fax |
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Provider Business Mailing Address
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Address Line | 111 W 67TH ST 20E
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City | NEW YORK
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State | NY
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Zip | 10023-5956
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 256477
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License Number State | NY
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